Examining CVD in Lupus: Insights from a Diverse Population-Based Registry

Announcer:
Welcome to Living Rheum on ReachMD. On this episode, we’ll hear from Dr. Peter Izmirly, who’s a Professor at NYU Grossman School of Medicine and the Co-Director of the NYU Lupus Clinic. He’ll be discussing his research on the prevalence of cardiovascular events in patients with lupus. Here’s Dr. Izmirly now.

Dr. Izmirly:
We’re not the first to explore cardiovascular disease and lupus. This has been described since the mid ‘70s, early ‘80s by other colleagues. And so we established a large registry of patients with lupus who we could validate had lupus by applying at the time the 1997 revised American College of Rheumatology Classification Criteria, but we also collected data on the SLICC classification criteria, and we also have employed the newer EULAR/ACR criteria that came out. And so we could clearly define lupus not by an ICD-9 code but by classification criteria in this cohort, and this registry generated data about the incidence and prevalence of lupus. But one of the benefits of this registry is that it’s population based, so it’s not sort of analyzing a tertiary or quaternary care cohort. And I think by the nature of what Manhattan was—and it was part of the reason we were funded originally—is that it comprises four of the major racial ethnic demographics in the United States. We have relatively large Hispanic and Asian populations in Manhattan. And also, by the nature of the population-based registry, we captured a substantive number of males. And lupus is a heavily skewed female to male disease. It’s roughly 9:1.

So we also caught the cardiovascular disease data as part of this registry and so we captured whether in the chart—again, not an ICD-9 code—but whether in the chart there’s documentation of a cardiovascular event, such as a heart attack or a stroke. We combined the two because we wanted greater power. And so again, there was data in the chart that an event actually happened. This was not relying on ICD-9 or the codes at the time. This is so old that ICD-9 codes were being employed at the time. This is prior to ICD-10. And then we compared it to population-based data about cardiovascular disease that were collected either in the NHANES or the New York City version of the NHANES—NHANES is the National Health and Nutrition Examination Survey of nurses. And then New York City also has data that’s limited. So the NHANES is national, and then we also looked at the data limited to just New York City nurses.

Well, we first looked only at cardiovascular events amongst lupus patients and we showed roughly 13 percent of lupus patients had a cardiovascular event. The overall 13.9 percent of patients had a cardiovascular event who met one of those criteria, and it was slightly higher in males than females; 21.3 percent of males had a cardiovascular compared to 13.3 in females. One of the greatest risk factors is age, so as you age, you are more likely to have a cardiovascular event. And we also looked at rates within lupus patients, and African Americans and Hispanic lupus patients had the highest rates of cardiovascular events. So if you had lupus depending on the denominator we used, you were anywhere between 3.1 or 4.4 times the risk of having a cardiovascular event. And the rates were relatively similar whether you’re a male or female, so that didn’t really substantively increase your risk, but the rates were considerably higher for lupus Hispanic patients and lupus African American patients. Unfortunately, the data on events in Asians in the population were so small that the numbers became unreliable, so we couldn’t report the ratio for Asian patients.

Announcer:
That was Dr. Peter Izmirly talking about the prevalence of cardiovascular events in patients with lupus. To access this and other episodes in our series, visit Living Rheum on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!