S. Garg, MD, MS, Assistant Professor, C.M. Bartels, MD, MS, Associate Professor, Rheumatology Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin;
S. Garg, MD, MS, Assistant Professor, C.M. Bartels, MD, MS, Associate Professor, Rheumatology Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
J Rheumatol. 2023 Jan;50(1):84-92. doi: 10.3899/jrheum.220279. Epub 2022 Aug 1.
Systemic lupus erythematosus (SLE) affects Black people 2 to 3 times more frequently than non-Black people and is associated with higher morbidity and mortality. In total, 4 studies with predominantly non-Black SLE cohorts highlighted that cardiovascular disease (CVD) is no longer primarily a late complication of SLE. This study assessed the timing and predictors of incident CVD in a predominantly Black population-based SLE cohort.
Incident SLE cases from the population-based Georgia Lupus Registry were validated as having a CVD event through review of medical records and matching with the Georgia Hospital Discharge Database and the National Death Index. The surveillance period for an incident CVD event spanned a 15-year period, starting from 2 years prior to SLE diagnosis.
Among 336 people with SLE, 253 (75%) were Black and 56 (17%) had an incident CVD event. The frequency of CVD events peaked in years 2 and 11 after SLE diagnosis. There was a 7-fold higher risk of incident CVD over the entire 15-year period; this risk was 19-fold higher in the first 12 years in Black people as compared to non-Black people with SLE. Black people with SLE ( < 0.001) and those with discoid rash (hazard ratio 3.2, 95% CI 1.4-7.1) had a higher risk of incident CVD events.
The frequency of incident CVD events peaked in years 2 and 11 after SLE diagnosis. Being Black or having a discoid rash were strong predictors of an incident CVD event. Surveillance for CVD and preventive interventions, directed particularly toward Black people with recent SLE diagnoses, are needed to reduce racial disparities.
红斑狼疮（SLE）影响黑种人 2 至 3 倍于非黑种人，且与更高的发病率和死亡率相关。共有 4 项主要纳入非黑种人 SLE 队列的研究表明，心血管疾病（CVD）不再是 SLE 的主要晚期并发症。本研究评估了一个主要为黑种人群的基于人群的 SLE 队列中 CVD 事件的发生时间和预测因素。
通过审查病历并与佐治亚州住院数据库和国家死亡指数相匹配，对基于人群的佐治亚州狼疮登记处的 SLE 病例进行验证，以确定是否发生 CVD 事件。CVD 事件的监测期跨越了 15 年，从 SLE 诊断前 2 年开始。
在 336 例 SLE 患者中，253 例（75%）为黑人，56 例（17%）发生 CVD 事件。SLE 诊断后 2 年和 11 年 CVD 事件的发生频率达到高峰。在整个 15 年期间，发生 CVD 的风险增加了 7 倍；与 SLE 的非黑人相比，黑人在 12 年内发生 CVD 的风险增加了 19 倍。黑人 SLE 患者（<0.001）和盘状皮疹患者（风险比 3.2，95%CI 1.4-7.1）发生 CVD 事件的风险更高。
SLE 诊断后 2 年和 11 年 CVD 事件的发生频率达到高峰。黑人或盘状皮疹是 CVD 事件发生的强烈预测因素。需要对近期诊断为 SLE 的黑种人进行 CVD 监测和预防干预，以减少种族差异。
