High risk of CV events in blacks with lupus

Black patients with systemic lupus erythematosus (SLE) had significantly higher risks of stroke and ischemic heart disease, with multiple risk factors for the two conditions, a researcher reported at the American College of Rheumatology’s annual virtual meeting.

Compared to white patients, blacks had a three times higher risk of stroke (HR 3.4, 95% CI 1.2-10, P.= 0.03) and a 24-fold increased risk of ischemic heart disease (HR 24, 95% CI 3-206, P.= 0.004), according to Shivani Garg, MD, of the University of Wisconsin at Madison.

Black lupus patients have been shown to have nearly 20 times higher risk of cardiovascular disease overall than other groups and also have three times higher rates of SLE, develop it at a younger age, and have worse disease. “Yet most previous studies of cardiovascular disease in lupus patients have focused primarily on white patients, limiting the generalizability of the findings,” Garg said.

These results emerged from analysis of data from the Georgia Lupus Registry, the Georgia Hospital Discharge Database, and the National Death Index for patients with incident SLE diagnosed from 2002 to 2004 and included 336 patients whose mean age at diagnosis was 40. 87% of the analysis consisted of women and 75% of blacks.

In the 2-year period prior to SLE diagnosis up to 16 years after diagnosis, 38 stroke events and 25 ischemic heart disease events occurred.

In 11% of stroke patients, the mean age at the time of the event was 48 years, with 78% in women and 90% in blacks. The maximum number of stroke events or deaths was reported in the second year after SLE diagnosis.

In 8% of patients with ischemic heart disease events, the mean age at the time of the event was 52 years; all were women and 96% were black. The maximum number of events was much later than in strokes, in the 14th year after the diagnosis of SLE.

Predictors of stroke were discoid eruption at the time of SLE diagnosis, with a five-fold increased risk (HR 4.6, 95% CI 1.7-13, P.= 0.003) and kidney disorders, with a double higher risk (HR 2.4, 95% CI 1.1-2.5, P.= 0.04). None of these disease features were associated with ischemic heart disease risks.

In contrast, predictors of ischemic heart disease were 65 years of age or older (HR 61, 95% CI 5.8-647, P.= 0.0007), neurological disorders (HR 4, 95% CI 1.3-13, P.= 0.02) and immunological disorders (HR 4.7, 95% CI 1.3-18, P.= 0.02), none of which were associated with an increased risk of stroke.

The discovery of a link between stroke and discoid rash was “surprising but interesting,” he noted.

Other studies have shown that the brain endothelium has a particular susceptibility to inflammation, he added. “We postulate that when patients present with lupus and discoid rash, this represents high levels of inflammation and, due to the cerebral endothelium which has a high affinity for inflammatory processes, there is plaque formation, destabilization and accelerated remodeling. of the arterial wall “.

Limitations of the study, Garg said, included its retrospective design and the fact that data on traditional risk factors and drug use were not uniformly collected across databases.