Ethnic Disparities in Atherosclerotic Cardiovascular Disease Incidence and Prevalence Among Rheumatoid Arthritis Patients in the United States: a Systematic Review

Abstract

Objective Rheumatoid arthritis (RA) is associated with increased atherosclerotic cardiovascular disease (ASCVD). General population cohorts have shown African American individuals to have greater and Hispanic Americans to have lower cardiovascular disease prevalence when compared with non‐Hispanic white individuals; however, the reasons for these findings are not clear. This systematic review seeks to describe the incidence and prevalence of ASCVD stratified by race/ethnicity within the US RA population. Methods MEDLINE, Embase, and Cochrane databases were searched for studies that reported incidence or prevalence of ASCVD (including, but not limited to, fatal and nonfatal stroke, myocardial infarction, and cardiovascular death) in those with RA. Abstracts and full texts were screened separately for inclusion by two reviewers, with a third reviewer to resolve discrepancies. Results We screened 2625 abstracts and fully reviewed 138 manuscripts. Twenty‐one were included that cited at a minimum the percentage of non‐Hispanic whites in their population. No publication meeting entry criteria initially stratified ASCVD by race/ethnicity. The average prevalent ASCVD in RA is 46.9% (95% CI: 46.8–47) (range of prevalent ASCVD: 30%‐47%). The average incident ASCVD is 8.2% (95% CI: 8.14–8.25) (range of incident ASCVD 1%–46%). Conclusion In this systematic review, we found a paucity of data on racially/ethnically diverse RA patients and ASCVD outcomes. Future studies should report the prevalence of ASCVD in various races/ethnicities with RA in the United States. These data would help inform clinicians on how best to manage cardiovascular disease risk in RA.

The cardiac effects of hydroxychloroquine in immune-mediated rheumatologic diseases

“…The risk seems to be highest in those with RA who are under age 50 years old, without regard to sex 12. A 2020 systematic review demonstrated a paucity of studies that stratify risk of CVD based on race or ethnicity 11…”

“…9 Patients with RA are at signifi cant increased risk of CVD compared with the general population, with one-third to one-half of premature deaths in patients with RA due to this increased incidence of CVD. 10,11 The risk seems to be highest in those with RA who are under age 50 years old, without regard to sex. 12 A 2020 systematic review demonstrated a paucity of studies that stratify risk of CVD based on race or ethnicity.…”

“…12 A 2020 systematic review demonstrated a paucity of studies that stratify risk of CVD based on race or ethnicity. 11 A meta-analysis of 19 studies involving more than 19,000 patients found that hydroxychloroquine use in patients with SLE or RA led to about a 30% reduction in CVD. 13 A reduction in CVD risk factors such as dyslipidemia, diabetes, and thrombosis or thromboembolism also was found in patients taking hydroxychloroquine, which reduces platelet aggregation and improves insulin sensitivity, glucose profi les, and lipid profi les.…”

Epigenome association study for DNA methylation biomarkers in buccal and monocyte cells for female rheumatoid arthritis

“…RA is characterized by synovial hyperplasia and joint destruction 3 . RA impacts both African American and Caucasian populations, but does have higher comorbidity 4 prevalence in African American populations. Coronary heart disease is more common in rheumatoid arthritis populations 4 , as in other chronic inflammatory diseases.…”

“…RA impacts both African American and Caucasian populations, but does have higher comorbidity 4 prevalence in African American populations. Coronary heart disease is more common in rheumatoid arthritis populations 4 , as in other chronic inflammatory diseases. Inflammatory lung disease is a common extra-articular manifestation 5 , along with rheumatoid nodules, secondary Sjogrens from endocrine gland inflammation, and more rarely rheumatoid vasculitis in this multisystem autoimmune disease.…”