Background:
Patients diagnosed with systemic lupus erythematosus (SLE) are at greater risk of cardiovascular disease (CVD) and death at earlier ages than the general population, with African Americans (AA) at risk at earlier ages than non-AAs. However, the association between race and recurrent hospitalizations for CVD, which are associated with mortality, has not been explored.
Methods:
The Georgia Lupus Registry (GLR) is a population-based registry of individuals with SLE in 2002-2004 in Atlanta, Georgia. Both incident and prevalent cases were enrolled, and we included all cases diagnosed beginning in 2000. The GLR was matched to Georgia inpatient hospital discharge records from 2000-2013. Using ICD-9-CM codes, we identified hospitalizations classified as having coronary heart disease, peripheral artery disease, cerebrovascular disease or heart failure. The Prentice-Williams-Peterson Model with a total time scale measured from diagnosis was used to examine recurrent time to event data. We truncated the number of hospitalizations at 3 to maintain stable modeling estimates. Patients were censored at the time of death or at the end of 2013. Models were adjusted for sex and age at diagnosis.
Results:
A total of 556 participants in the GLR (87% female, 73% AA) had a median age at SLE diagnosis of 38 years and 27% experienced at least 1 CVD hospitalization, while 17% experienced ≥ 2. Overall, AA race was associated with recurrent hospitalizations (adjusted hazard ratio [aHR]: 1.7, 95% confidence interval [CI]: 1.2, 2.3). In an event-specific stratified analysis, the association between AA race and the hazard of recurrence became even more pronounced in later events (Event 1 aHR: 1.2, 95% CI: 1.0, 1.5; Event 2 aHR: 1.5, 95% CI: 1.2, 2.2; Event 3 aHR: 1.9, 95% CI: 1.1, 3.2).
Conclusions:
African-Americans with SLE were more likely to experience recurrent hospitalizations for CVD than their non-AA counterparts, suggesting that AA individuals with SLE may be more vulnerable to CV complications of SLE. Figure 1. Survival curve for 1st event
Genetic fine mapping of systemic lupus erythematosus MHC associations in Europeans and African Americans
