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Race/Ethnicity and Cardiovascular Events Among Patients With Systemic Lupus Erythematosus
Medha Barbhaiya1, Candace H Feldman1, Hongshu Guan1
1Brigham and Women's Hospital, Boston, Massachusetts.
Insights
Systemic lupus erythematosus (SLE) patients face higher cardiovascular disease (CVD) risks. Black and Hispanic SLE patients had increased stroke risk, while Hispanic and Asian patients had lower heart attack risk compared to white patients.
Area of Science:
- Rheumatology
- Cardiology
- Health Disparities
Background:
- Systemic lupus erythematosus (SLE) disproportionately affects minority populations, leading to more severe outcomes.
- Cardiovascular disease (CVD) is the primary cause of mortality in individuals with SLE.
- Understanding racial and ethnic variations in CVD risk is crucial for targeted interventions in SLE management.
Purpose of the Study:
- To investigate racial and ethnic differences in the risk of cardiovascular events among patients diagnosed with Systemic Lupus Erythematosus (SLE).
- To analyze disparities in myocardial infarction (MI) and stroke incidence across different racial and ethnic groups within the SLE population.
Main Methods:
- Utilized the Medicaid Analytic eXtract (MAX) database from 2000-2010, identifying adult SLE patients with continuous enrollment.
- Employed Cox regression models to estimate hazard ratios (HRs) for CVD events, adjusting for demographics and comorbidities.
- Calculated race/ethnicity-specific annual CVD event rates and followed patients for a median of 3.8 years.
Main Results:
- Black SLE patients exhibited the highest CVD event rates (IR 10.57), while Asian patients had the lowest (IR 6.63).
- Compared to white patients, Black SLE patients had a higher risk of overall CVD events (HR 1.14).
- Hispanic and Asian patients showed a reduced risk of myocardial infarction (MI), whereas Black and Hispanic patients had an elevated risk of stroke.
Conclusions:
- Racial and ethnic disparities exist in CVD event risk among Systemic Lupus Erythematosus patients.
- Hispanic and Asian SLE patients experienced lower MI risk, but Black and Hispanic patients faced higher stroke risk compared to white patients.
- These findings highlight the need for tailored CVD prevention strategies based on race and ethnicity in SLE management.
Objective:
Systemic lupus erythematosus (SLE) is more prevalent and results in more severe outcomes among blacks, Asians, and Hispanics than among whites. Cardiovascular disease (CVD) is the leading cause of death among SLE patients. We undertook this study to examine racial/ethnic variations in risk of CVD events among SLE patients.
Methods:
Within the Medicaid Analytic eXtract from 2000 to 2010, we identified patients ages 18-65 years with SLE (≥3 International Classification of Diseases, Ninth Revision 710.0 codes, ≥30 days apart) and with ≥12 months of continuous enrollment. Subjects were followed up from the index date to the first CVD event (myocardial infarction [MI] or stroke), death, disenrollment, loss to follow-up, or end of follow-up period. Race/ethnicity-specific annual CVD event rates were calculated. Cox regression models estimated hazard ratios (HRs) with 95% confidence intervals (95% CIs), accounting for competing risk of death and adjusting for baseline demographics and comorbidities.
Results:
Of 65,788 SLE patients, 93.1% were women and ∼42% were black, 38% were white, 16% were Hispanic, 3% were Asian, and 1% were American Indian/Alaska Native. Mean ± SD follow-up was 3.8 ± 3.1 years. CVD event rates were highest among blacks (incidence rate [IR] 10.57 [95% CI 9.96-11.22]) and lowest among Asians (IR 6.63 [95% CI 4.97-8.85]). After multivariable adjustment, risk of CVD events was increased among blacks (HR 1.14 [95% CI 1.03-1.26]) compared to whites. Hispanics and Asians had a lower risk of MI (HR 0.61 [95% CI 0.48-0.77] and HR 0.57 [95% CI 0.34-0.96], respectively), while blacks and Hispanics had a higher risk of stroke (HR 1.31 [95% CI 1.15-1.49] and HR 1.22 [95% CI 1.03-1.44], respectively).
Conclusion:
Among SLE patients enrolled in Medicaid, the risk of MI was lower among Hispanics and Asians compared to whites, while the risk of stroke was elevated among blacks and Hispanics compared to whites.
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