Summary of findings from selected studies
| Author(s), year | Themes explored | Study objective | Study population | Methodology | Key findings |
| Pons-Estel et al, 200944 | Socioeconomic status; education; race; gender; other: marital status | To determine the features predictive of atherosclerotic damage in patients with SLE (using SLICC damage index: cardiovascular domain) | LUMINA (Lupus in MInorities, NAture vs nurture) cohort comprised of 637 Hispanic, African-American and white patients who meet at least 4 ACR criteria for SLE, are>16 years, and have disease duration<5 years. | Longitudinal—logistic regression | Male gender was associated with CV damage in univariate and multivariate analyses. Years of education was negatively associated with CV damage. |
| Scalzi et al, 201050 | Race and/or ethnicity | To determine whether racial disparities exist with regard to the age at which patients with SLE experience CVD and CVD-associated death | Clinical records for all adult patients>18 years identified as having SLE by ICD-9 classification were obtained from the Nationwide Inpatient Sample (NIS) database. | Cross-sectional—logistic regression | Black women with SLE were the youngest to experience CVD, while white patients were significantly younger than racialized groups. Black patients were 9.6 years younger than white patients at the time of first CVD hospitalisation. Black women were the youngest to have in-hospital CVD-associated death and had a consistent decline in mortality with age. |
| Maynard et al, 201246 | Socioeconomic status; education; race | To investigate whether education or income levels are associated with cardiovascular risk factors and outcomes in SLE | 1752 patients from the Hopkins Lupus Cohort with SLE as diagnosed by the principal investigator who were either white or African American. | Longitudinal—logistic regression | Both income and education were associated with cardiovascular risk factors and outcomes, but these relationships differed for African American and white groups. |
| Rhew et al, 200949 | Socioeconomic status; education; race | To compare traditional and SLE-related risk factors for CVD, and to compare the various measures of subclinical CVD in African American and white women with SLE | 309 women from the Chicago Lupus Database and Pittsburgh Lupus Registry who met at least 4 ACR criteria for SLE, were>18 years, and had no history of CVD events. Only African American and white patients included. | Cross-sectional—logistic regression | African American women with SLE are twice as likely to have carotid plaque, and more frequently exhibited traditional risk factors for CVD than white women with SLE. |
| Tan et al, 201251 | Race and/or ethnicity; gender | To compare key clinical characteristics of SLE among male and female patients in a multiethnic population | 1979 patients with SLE from the Hopkins Lupus Cohort who were white or African American. | Cross-sectional—comparative | African American men with SLE were more likely than white men with SLE to have CV damage and hypertension. |
| Jorge et al, 201752 | Race; mental health | To evaluate the relationship between depression and progression of subclinical atherosclerosis in women with SLE | 149 women with SLE from the SOLVABLE cohort who met at least 4 ACR criteria for SLE and were>18 years. 126 healthy controls were matched by age, ethnicity and zip code. | Longitudinal—logistic and linear regression, multivariate analyses | Patients with SLE had significantly higher depression at baseline than those without. Baseline depression was associated with increased progression of carotid intima-media thickness (CIMT), but not carotid plaque, in the SLE group, and this was independent of traditional risk factors. |
| Greco et al, 201245 | Education; mental health | To evaluate the association between depression and vascular disease in SLE | 161 women with SLE from the Pittsburgh Lupus Registry that met at least 4 ACR criteria for SLE, were>18 years, and had no history of CVD. | Cross-sectional – logistic regression | Years of education was associated with vascular disease. Depression was more prevalent among women with SLE who had vascular disease, compared with those without. Patients with depression had nearly 4-fold increased odds of developing vascular disease independent of traditional risk factors. |
| Lee et al, 200847 | Socioeconomic status; education; ethnicity; gender; insurance; other: marital status | To evaluate the effects of treatment and demographic, anthropometric and socioeconomic variables on high sensitivity C-reactive protein (hsCRP) levels as an indicator of cardiovascular risk in SLE | 610 patients with SLE from the Hopkins Lupus Cohort who met at least four ACR criteria for SLE. | Cross-sectional—logistic regression | Levels of hsCRP were associated with ethnicity and education level. African-American patients had significantly higher hsCRP levels than other ethnic groups. Patients with high hsCRP levels were more often African American, less educated, lower income and publicly or not insured. |
| Walunas et al, 201753 | Healthcare fragmentation; race; insurance | To examine the impact of healthcare fragmentation (healthcare received from multiple healthcare institutions/ providers) on disease outcomes in patients with SLE. | Clinical records for 4, 276 patients aged 18–69 years that were identified as having SLE by ICD-9 classification, as obtained from the Chicago HealthLNK Data Repository. | Cross-sectional—logistic regression | SLE patients with fragmented care had increased odds of CVD outcomes. African American patients with public insurance and fragmented care were over seven times more likely to develop CVD than the general population, suggesting a relationship between care fragmentation, race and health insurance. |
ACR, American College of Rheumatology; CVD, cardiovascular disease; ICD-9, International Classification of Diseases, Ninth Revision; SLE, systemic lupus erythematosus; SLICC, Systemic Lupus Erythematosus International Collaborating Clinics.