Predictors of Incident Cardiovascular Disease Assessed Among Black Patients With SLE

The timing and predictors of incident CVD among a predominantly Black population with SLE were evaluated.

In patients with systemic lupus erythematosus (SLE), being Black and having a discoid rash are strong predictors of an incident cardiovascular disease (CVD) event, according to study results published in The Journal of Rheumatology.

The researchers sought to evaluate the timing and predictors of incident CVD in a predominantly Black population-based SLE cohort.

Patients with SLE enrolled in the Georgia Lupus Registry were validated as experiencing a CVD event using medical records, as well as with matching with the Georgia Hospital Discharge Database and the National Death Index. The surveillance period for an incident CVD event was 15 years, which began 2 years prior to a diagnosis of SLE.

CVD events were defined as ischemic heart disease (IHD, ie, myocardial infarction, coronary artery revascularization, abnormal stress test or echocardiogram, ≥50% abnormal angiogram, events documented by a cardiologist); cerebrovascular disease (ie, thrombotic and ischemic stroke, transient ischemic attack); and peripheral vascular disease (PVD, ie, abnormal ankle-brachial index, abnormal peripheral angiography, limb ischemia when undergoing bypass surgery or angioplasty, or documented by a surgeon).

A total of 336 individuals with SLE were enrolled in the study. Overall, 87% of the participants were women and 75% were Black. The mean participant age at SLE diagnosis was 40 (SD, 17) years.

Results of the study showed that 17% (n=56) of the participants had incident CVD, with 33 with cerebrovascular disease, 20 with IHD, and 3 with PVD. The frequency of CVD events peaked at 2 and 11 years following a diagnosis of SLE.

Surveillance for CVD and preventive interventions, directed particularly toward Black people with recent SLE diagnoses, are needed to reduce racial disparities.

Researchers noted more than a 7-fold higher risk for incident CVD during the 15-year study period (adjusted hazard ratio [aHR], 7.3; 95% CI, 2.4-22.0), with this risk 19-fold higher among Black vs non-Black participants with SLE (aHR, 19.0; 95% CI, 3.0-142.0).

Being older than 65 years at SLE diagnosis and having a renal disorder were also found to be predictors of CVD events.

Further, Black patients with SLE (P <.001) and those with a discoid rash (aHR, 3.2; 95% CI, 1.4-7.1) had a higher risk for incident CVD events.

Study limitations included that certain CVD events may have been overlooked as a result of migration or unavailability of records; White patients with SLE being underrepresented in the study cohort; the small sample size; and the unavailability of smoking status, which is a known risk factor for both discoid rash and CVD.

The study authors concluded, “Surveillance for CVD and preventive interventions, directed particularly toward Black people with recent SLE diagnoses, are needed to reduce racial disparities.”


Garg S, Bartels CM, Bao G, Helmick CG, Drenkard C, Lin SS. Timing and predictors of incident cardiovascular disease in systemic lupus erythematosus: risk occurs early and highlights racial disparities. J Rheumatol. 2023;50(1):84-92. doi:10.3899/jrheum.220279