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Black patients with systemic lupus erythematosus (SLE) are more likely than whites to have a cardiovascular event, but Hispanics, Asians, and American Indians/Alaska natives with SLE are less likely than whites to experience a CV event, according to a study involving almost 66,000 Medicaid patients.
In a comparison of incidence rate ratios with whites as the reference group (IRR, 1.0), black patients with SLE had an IRR of 1.18 for cardiovascular events (defined as a first acute myocardial infarction or stroke), Hispanic patients had an IRR of 0.84, Asians had an IRR of 0.75, and American Indians/Alaska natives had an IRR of 1.06, reported Medha Barbhaiya, MD, MPH, of Brigham and Women’s Hospital, Boston, and her associates (Arthritis Rheumatol. 2017. doi: 10.1002/art.40174).
The substantial reduction in MI risk among Hispanics and Asians, compared with white SLE patients, suggests an “Hispanic and Asian paradox” since “SLE has been reported to be more prevalent, more severe, and to result in more end-organ damage in Hispanics and Asians compared to white patients,” Dr. Barbhaiya and her associates wrote.
The data for 65,788 cases of SLE from Jan. 1, 2000, to Dec. 31, 2010, were taken from the Medicaid Analytic eXtract, which contains all Medicaid billing claims from the 29 most populous states. Over a mean follow-up of 3.8 years, those SLE patients had 2,259 first-CV events, which works out to an overall incidence rate of 9.31 per 1,000 person-years.
The study was supported by awards from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Barbhaiya and one of her associates are supported by awards from the Rheumatology Research Foundation. The investigators did not disclose any conflicts.
In the 1,000 Faces of Lupus study, which showed a comparable racial and ethnic paradox, “lower annual income was associated with more health care barriers” and “difficulty in obtaining medications was associated with higher disease activity,” Janet E. Pope, MD, and her associates said in an accompanying editorial.
“The observed ‘paradox’ from the Barbhaiya study may be the result of complex interactions between environmental, cultural, socioeconomic, psychosocial, genetic, and other clinical factors. 
Dr. Pope is with the University of Western Ontario in London. Her coauthors were Michael H. Weisman, MD, who is with Cedars-Sinai Medical Center in Los Angeles and Christopher Sjöwall, MD, of Linköping (Sweden) University.
In the 1,000 Faces of Lupus study, which showed a comparable racial and ethnic paradox, “lower annual income was associated with more health care barriers” and “difficulty in obtaining medications was associated with higher disease activity,” Janet E. Pope, MD, and her associates said in an accompanying editorial.
“The observed ‘paradox’ from the Barbhaiya study may be the result of complex interactions between environmental, cultural, socioeconomic, psychosocial, genetic, and other clinical factors.
Dr. Pope is with the University of Western Ontario in London. Her coauthors were Michael H. Weisman, MD, who is with Cedars-Sinai Medical Center in Los Angeles and Christopher Sjöwall, MD, of Linköping (Sweden) University.
In the 1,000 Faces of Lupus study, which showed a comparable racial and ethnic paradox, “lower annual income was associated with more health care barriers” and “difficulty in obtaining medications was associated with higher disease activity,” Janet E. Pope, MD, and her associates said in an accompanying editorial.
“The observed ‘paradox’ from the Barbhaiya study may be the result of complex interactions between environmental, cultural, socioeconomic, psychosocial, genetic, and other clinical factors.
Dr. Pope is with the University of Western Ontario in London. Her coauthors were Michael H. Weisman, MD, who is with Cedars-Sinai Medical Center in Los Angeles and Christopher Sjöwall, MD, of Linköping (Sweden) University.
Black patients with systemic lupus erythematosus (SLE) are more likely than whites to have a cardiovascular event, but Hispanics, Asians, and American Indians/Alaska natives with SLE are less likely than whites to experience a CV event, according to a study involving almost 66,000 Medicaid patients.
In a comparison of incidence rate ratios with whites as the reference group (IRR, 1.0), black patients with SLE had an IRR of 1.18 for cardiovascular events (defined as a first acute myocardial infarction or stroke), Hispanic patients had an IRR of 0.84, Asians had an IRR of 0.75, and American Indians/Alaska natives had an IRR of 1.06, reported Medha Barbhaiya, MD, MPH, of Brigham and Women’s Hospital, Boston, and her associates (Arthritis Rheumatol. 2017. doi: 10.1002/art.40174).
The substantial reduction in MI risk among Hispanics and Asians, compared with white SLE patients, suggests an “Hispanic and Asian paradox” since “SLE has been reported to be more prevalent, more severe, and to result in more end-organ damage in Hispanics and Asians compared to white patients,” Dr. Barbhaiya and her associates wrote.
The data for 65,788 cases of SLE from Jan. 1, 2000, to Dec. 31, 2010, were taken from the Medicaid Analytic eXtract, which contains all Medicaid billing claims from the 29 most populous states. Over a mean follow-up of 3.8 years, those SLE patients had 2,259 first-CV events, which works out to an overall incidence rate of 9.31 per 1,000 person-years.
The study was supported by awards from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Barbhaiya and one of her associates are supported by awards from the Rheumatology Research Foundation. The investigators did not disclose any conflicts.
Black patients with systemic lupus erythematosus (SLE) are more likely than whites to have a cardiovascular event, but Hispanics, Asians, and American Indians/Alaska natives with SLE are less likely than whites to experience a CV event, according to a study involving almost 66,000 Medicaid patients.
In a comparison of incidence rate ratios with whites as the reference group (IRR, 1.0), black patients with SLE had an IRR of 1.18 for cardiovascular events (defined as a first acute myocardial infarction or stroke), Hispanic patients had an IRR of 0.84, Asians had an IRR of 0.75, and American Indians/Alaska natives had an IRR of 1.06, reported Medha Barbhaiya, MD, MPH, of Brigham and Women’s Hospital, Boston, and her associates (Arthritis Rheumatol. 2017. doi: 10.1002/art.40174).
The substantial reduction in MI risk among Hispanics and Asians, compared with white SLE patients, suggests an “Hispanic and Asian paradox” since “SLE has been reported to be more prevalent, more severe, and to result in more end-organ damage in Hispanics and Asians compared to white patients,” Dr. Barbhaiya and her associates wrote.
The data for 65,788 cases of SLE from Jan. 1, 2000, to Dec. 31, 2010, were taken from the Medicaid Analytic eXtract, which contains all Medicaid billing claims from the 29 most populous states. Over a mean follow-up of 3.8 years, those SLE patients had 2,259 first-CV events, which works out to an overall incidence rate of 9.31 per 1,000 person-years.
The study was supported by awards from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Barbhaiya and one of her associates are supported by awards from the Rheumatology Research Foundation. The investigators did not disclose any conflicts.
FROM ARTHRITIS AND RHEUMATOLOGY
Key clinical point:
Major finding: With whites as the reference group, incidence rate ratios of cardiovascular disease were 1.18 for blacks, 1.06 for American Indians/Alaska natives, 0.84 for Hispanics, and 0.75 for Asians.
Data source: 65,788 cases of SLE from Jan. 1, 2000, to Dec. 31, 2010, were taken from the Medicaid Analytic eXtract.
Disclosures: The study was supported by awards from the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Dr. Barbhaiya and one of her associates are supported by awards from the Rheumatology Research Foundation. The investigators did not disclose any conflicts.