Black Lupus Patients Heart Attack and Stroke

Black lupus patients have a far greater risk of stroke and ischemic heart disease (IHD) than other groups, and there are several lupus-specific symptoms that may predict stroke and heart disease in Black people with lupus, according to new research.

Systemic lupus erythematosus (SLE) — the most common form of lupus — is a chronic disease that causes systemic inflammation in multiple organs, such as the skin, joints, kidneys, lungs, heart, and brain. Lupus is more common in Black, Asian, and Native American people than in white people and it is also often worse for these groups.

In a new study presented at ACR Convergence 2020, the annual meeting of the American College of Rheumatology, researchers collected data from the Georgia Lupus Registry, a group of lupus patients in Atlanta who are followed over time. Researchers matched lupus patients from 2002 to 2004 with other patients in the Georgia Hospital Discharge Database and National Death Index from 2000 to 2013.

The researchers based stroke-related and ischemic heart disease-related hospitalizations and deaths on hospital admission and death medical codes. Of the 336 lupus patients included in the study, 75 percent were Black, 87 percent were female, and the average age of lupus diagnosis was 40.

Overall, there were 38 stroke-related and 25 ischemic heart disease-related health events or deaths that occurred anywhere from two years before to 14 years after the patients were were diagnosed with lupus. Ninety percent of strokes occurred in Black patients (with the peak number occurring in the second year after a lupus diagnosis) and 96 percent of ischemic heart disease cases were found in Black patients (with the peak number occurring in the 14th year after diagnosis).

This translates to a threefold higher stroke risk and 24-fold higher ischemic heart disease risk for Black lupus patients than other groups.

The researchers also found that of the 11 percent of total patients who had strokes, there was an average age of 48 for a first stroke and 78 percent of strokes occurred in females.

Of the 8 percent of total patients who had ischemic heart disease, there was an average age of 52 for diagnosis and all cases occurred in females.

Researchers also identified certain predictors of stroke or ischemic heart disease:

  • Discoid rash (which produces coin-shaped lesions) at the time of a lupus diagnosis was linked to a five-fold higher risk of stroke.
  • Renal (kidney) disorder at the time of diagnosis predicted a two-fold higher stroke risk.

However, neither of these symptoms predicted ischemic heart disease. Neurologic disorders (like prior psychosis or seizure) and immunologic disorders were strong predictors of ischemic heart disease, but not stroke.

These results underscore significant racial disparities in stroke and heart disease risk among individuals who have lupus, said the study’s co-author, Shivani Garg, MD, Assistant Professor of Medicine at the University of Wisconsin School of Medicine and Public Health, in a press release.

“It’s important to quantify the risk, predictors, and timing of stroke and ischemic heart disease in Black people with lupus in order to guide early cardiovascular disease diagnosis and preventive interventions in this at-risk population,” said Dr. Garg. “Timely interventions could help reduce cardiovascular disparities in lupus and reduce cardiovascular disease-related morbidity and mortality in young lupus patients, who are at relatively higher risk of premature cardiovascular disease.”

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Garg S, et al. Racial Disparities and New SLE-Specific Predictors of Stroke and Ischemic Heart Disease in Patients with Lupus [abstract]. Arthritis & Rheumatology. November 2020.

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