Elsevier

Translational Research

Volume 153, Issue 2, February 2009, Pages 51-59
Translational Research

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Differences in subclinical cardiovascular disease between African American and Caucasian women with systemic lupus erythematosus

https://doi.org/10.1016/j.trsl.2008.11.006Get rights and content

Racial differences exist in disease rates and mortality in both cardiovascular disease (CVD) and systemic lupus erythematosus (SLE). The objective of this cross-sectional study was to compare the frequency and risk factors for subclinical CVD in African American (AA) and Caucasian women with SLE and no prior CVD events. Traditional CVD risk factors and SLE-related factors were assessed in 309 SLE women. Subclinical CVD was assessed by carotid ultrasound to measure intimamedial thickness (IMT) and plaque, and electron beam computed tomography (EBCT) was used to measure coronary artery calcium (CAC). AA women had less education and higher levels of body mass index, blood pressure, lipoprotein(a), C-reactive protein (CRP), fibrinogen, and erythrocyte sedimentation rate (ESR). However, AA women had lower albumin, more and longer duration of corticosteroid use, higher SLE disease activity and damage, and more dsDNA antibodies compared with Caucasian women after adjustment for age and study site. More AA women had carotid plaque (adjusted odds ratio [OR], 1.94; 95% confidence interval [CI], 1.03–3.65) and higher carotid IMT (0.620 vs 0.605 mm, P = 0.07) but similar CAC compared with Caucasians. A multivariate analysis revealed that the following risk factor variables were significantly different between the racial groups and associated with plaque: blood pressure, current corticosteroid use, SLE disease activity, and SLE damage. All factors contributed to the result, but no individual risk factor fully accounted for the association between race and plaque. In conclusion, the presence of carotid plaque was higher in AA compared with Caucasian women with SLE, in contrast to studies of non-SLE subjects, in which AA have similar or less plaque than Caucasians. A combination of SLE-related and traditional CVD risk factors explained the racial difference in plaque burden.

Section snippets

Study population

A total of 309 SLE women, all of whom met at least 4 classification criteria for SLE, aged 18 years or older, and without a history of clinical CVD events (which included myocardial infarction [MI], angina, percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery, cerebrovascular accident [CVA], or transient ischemic attack [TIA]), were enrolled from the Chicago Lupus Database and the Pittsburgh Lupus Registry for the purposes of this study. The Chicago Lupus

Results

In all, 309 SLE women were included in the analysis from both sites; 63 women were AA, and 246 women were Caucasian. AA women were significantly younger compared with the Caucasian women (44.6 ±10.3 years vs 47.6 ±10.6 years, P < 0.05), but this difference in age was no longer significant after adjustment for study site.

Discussion

This study is the first to investigate racial differences in subclinical CVD at various vascular beds in SLE women. We found that AA women with SLE are 2 times more likely to have carotid plaque than Caucasians. In our study, the traditional risk factors that were more prevalent in AA women with lupus included higher levels of blood pressure, BMI, and lipoprotein(a). Education level was slightly lower in AAs. For lupus-related factors, AAs had more disease activity, greater disease damage, more

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    Supported by grants T32-AR07611, F32-AR51681, and K23-AR054418 from the National Institutes of Health (NIH) and Mary Kirkland Center for Lupus Research and Rheuminations, Inc. (to E.R.); by grants NIH K24-AR02318, P60-AR30692, P60-AR48098, NCRR/GCRC, and M01-RR00048 (to R.R.G.); by grants NIH R01-AR046588 and K24-AR002213 (to S.M.); and by grant NIH K23 AR051044 and the American College of Rheumatology/REF Physician Scientist Development Award (to A.H.K.).

    Elisa Y. Rhew, MD, MSCI, is Assistant Professor of Medicine, Division of Rheumatology at Northwestern University, Feinberg School of Medicine. Her article is based on a presentation given at the Combined Annual Meeting of the Central Society for Clinical Research and Midwestern Section American Federation for Medical Research held in Chicago, Ill, April 2008.

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