Funding This study was supported by the Rheumatology Research Foundation Investigator Award (PI: Ardalan).

Disclosures

• KA – Cure JM Foundation (support for clinical trial design with ReveraGen BioPharma)

• LES – Bristol Myers Squibb (research grant), Sanofi (DSMB), UCB (DSMB)

• EYW – Pharming Healthcare, Inc (advisory board, speaker bureau); Enzyvant Therapeutics

Background/Purpose Juvenile lupus (JSLE) and dermatomyositis (JDM) are independent predictors of cardiovascular disease (CVD). The American Heart Association (AHA) defines cardiovascular health (CVH) as the behavioral and biological factors that decrease CVD risk. Prior studies report high rates of hypertension, obesity, and dyslipidemia in JSLE/JDM, but CVH per se has not been assessed in this population. We present baseline cross-sectional data from the Lupus Erythematosus and Dermatomyositis Stress and Cardiovascular Health (LEADS-CV) study describing CVH in JSLE/JDM patients.

Methods JSLE/JDM patients (5–22yo) were enrolled into the LEADS-CV study at Duke and UNC Children’s Hospitals. CVH Behaviors (CVH-B) indicators included diet quality screener and PROMIS Physical Activity. CVH Factors (CVH- F) indicators included body mass index, blood pressure, non-HDL cholesterol, and HbA1c. CVH Summary (CVH-S; all CVH-B and CVH-F indicators) as well as CVH-B and CVH-F scores were derived per the AHA’s Life’s Essential 8 algorithm (range 0–100, higher scores indicate better CVH). Per AHA guidelines, ideal CVH was defined as a score of 100 for CVH-S/-B/-F and individual CVH indicators. Rank sum tests compared median CVH-S/-B/-F and indicator scores across subgroups (i.e. race/ethnicity, age, JSLE vs JDM diagnosis, gender, and corticosteroid use).

Results Data for 83 patients are summarized in table 1. Forty-three percent of participants had a prior history of at least one CVD risk factor/comorbidity (table 1). None of the participants had ideal CVH-S or CVH-B scores and only a small minority (16.9%) had ideal CVH-F scores. Ideal diet and physical activity were least prevalent (< 5% each), while ideal HbA1c was most prevalent (88%) (table 1). Statistically significant differences were noted for CVH-S by diagnosis (worse in JSLE than JDM) (table 2). CVH-B scores were significantly lower in minority race/ethnicity participants, ≥16yo JSLE/JDM patients, and in JSLE vs JDM patients (table 2). Patients on steroids had lower CVH-F scores than those not on steroids (table 2). Diet and physical activity indicator scores were worse in ≥16yo patients. Physical activity indicator scores were worse in minority race/ethnicity and JSLE patients (table 3). Non-HDL cholesterol indicator scores were worse in patients on steroids, as well as those < 16 yo (table 3).

Conclusion Ideal CVH-S is exceedingly rare in JSLE/JDM, driven predominantly by non-ideal CVH-B. Minority race/ethnicity and JSLE (vs JDM) diagnosis were associated with worse CVH-S and CVH-B, suggesting health disparities may lead to disparate lifetime risks of CVD. Age-based differences in CVH-S and CVH-B indicate that adolescence and young adulthood are high-risk periods for worsening of CVH and opportune times for intervening to promote CVH. Further analyses of LEADS-CV data will identify which social determinants of health, clinical features, and psychosocial factors are most strongly associated with CVH in JSLE/JDM patients.