African-Americans with Rheumatoid Arthritis and Like Diseases at Cardiovascular Risk

African-Americans with Rheumatoid Arthritis and Like Diseases at Cardiovascular Risk

Research conducted into the medical records of over a quarter million adults found that African-Americans with connective tissue diseases such as rheumatoid arthritis are twice as likely as whites with these diseases to suffer complications that increase their likelihood of having a heart attack or stroke. The study, “The Prevalence of Atherosclerosis in Those with Inflammatory Connective Tissue Disease by Race, Age, and Traditional Risk Factors” published in the journal Scientific Reports, also found an especially high prevalence of narrowed blood vessels in young African-Americans with connective tissues diseases.

“These findings raise new questions about the links between inflammation, connective tissue diseases and atherosclerotic cardiovascular disease,” the study’s author, Francis Alenghat, MD, PhD, assistant professor of medicine in the section of cardiology at the University of Chicago, said in a news release. “They point to differences in heart disease risk tied to systemic inflammation and modified by race and age.”

Inflammation promotes cardiovascular disease, and inflammatory connective tissue diseases (CTD) are associated with an increased risk for cardiovascular complications. Whether specific patients have greater susceptibility for atherosclerotic cardiovascular disease (ASCVD) associated with CTD, however, has rarely been investigated.

Before this analysis, in fact, there was “a dearth of formal understanding on interactions of race with connective tissue diseases in determining cardiovascular risk,” Dr. Alenghat said.

The study used medical charts and information covering 287,000 African-Americans and Caucasians who were among the  “the large, diverse patient population” treated at the university’s medical center. In total, results revealed that 10 percent of African-American patients had atherosclerotic cardiovascular disease, compared to a 8.4 percent of white patients. Atherosclerotic cardiovascular disease included heart attacks, ischemic heart disease, anginas, coronary artery disease, or atherosclerotic disease in any artery.

Almost 30 percent of African-Americans with connective tissue disease were also found to have cardiovascular disease, three times as many as African-Americans without CTD. In contrast, 15 percent of Caucasians with connective tissue disease had cardiovascular disease, representing a 1.8 times greater incidence than whites without CTD. African-Americans with connective tissue disease also developed cardiovascular disease at younger ages than Caucasian CTD patients (9 percent were 18–44), and they were 4.7 times more likely to have atherosclerosis than Caucasian patients of comparative age.

“The molecular and cellular causes of each connective tissue disease are distinct,” Dr. Alenghat said. “But they all involve systemic inflammation.” Data from this study suggest that “we should consider lower thresholds for primary prevention in many patients with CTD,” he added.

Although the study had some limitations, “the findings show that CTD is associated with higher prevalence of atherosclerotic cardiovascular disease, an association that is accentuated in African-Americans and in young adults,” Dr. Alenghat said. “These insights could be used to improve how we evaluate many patients with a wide range of connective tissue diseases.”

The results also support the importance of controlling inflammation, and identifying and addressing well-established risk factors for cardiovascular disease. “If we were to view the current findings on the backdrop of contemporary cardiovascular risk calculators and statin guidelines, many patients with connective tissue disease could reasonably consider moderate-intensity statin therapy at age 35,” he concluded.

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