The Prevalence of Atherosclerosis in Those with Inflammatory Connective Tissue Disease by Race, Age and Traditional Risk Factors

Abstract

Systemic inflammation promotes cardiovascular disease. Inflammatory connective tissue diseases (CTD) like lupus and rheumatoid arthritis associate with cardiovascular risk, but it is unknown whether particular groups of patients have enhanced propensity for atherosclerotic cardiovascular disease (ASCVD) associated with their CTD. Analysis of aggregate health record data at a large U.S. academic center identified CTD and ASCVD status for 287,467 African American and white adults. ASCVD prevalence in those with CTD was 29.7% for African Americans and 14.7% for white patients with prevalence ratios, compared to those without CTD, of 3.1 and 1.8, respectively. When different types of CTD were analyzed individually (rheumatoid arthritis; lupus; scleroderma; Sjögren Syndrome; dermatomyositis/polymyositis; unspecified/mixed CTD; other inflammatory arthropathy), increased ASCVD rates were found in nearly all subsets, always with higher prevalence ratios in African Americans. The prevalence ratio of ASCVD was particularly high in young African Americans. Furthermore, individuals lacking traditional cardiovascular risk factors had more ASCVD if they had CTD (prevalence ratio 2.9). Multivariate analysis confirmed a positive interaction between CTD and African-American race and a negative interaction between CTD and age. The factors driving the observed disproportionate CTD-associated ASCVD in African Americans, young adults, and those without traditional risk factors warrant further study.

Impact of Historic Migrations and Evolutionary Processes on Human Immunity

“…A study involving 12 000 African American and Hispanic American women found that the higher values of C-reactive protein (CRP) in blood found in these populations compared with European Americans were related to a CRP-associated variant of triggering receptors expressed by myeloid cells 2 (TREM2) [47]. Moreover, comparison of health record data from individuals with connective tissue diseases, including rheumatoid arthritis and systemic lupus erythematosus (SLE), as well as atherosclerotic cardiovascular disease from almost 300 000 African American and European American adults was conducted; the study reported for the latter, a prevalence of atherosclerotic cardiovascular disease in 29.7% African Americans (particularly high in young individuals), relative to 14.7% in European Americans [48]. These studies highlight certain genetic links to inflammatory predisposition/manifestation.…”

Staphylococcus pasteuri isolates (Spvs) from human atherosclerotic plaques mediate virulence, intracellular resistance and transendothelial invasion of macrophages: A mechanistic paradigm for microbial pathogenicity in atherosclerosis

“…This suggests that these bacteria may be dormant but can be activated as seen in our in vitro studies. A total of 17 colonies were grown in pure culture (clones 1,2,3,4,11,13,14,15,16,17,18,19,20, CE1, CE2, CE3 and CE4). 15 isolates from pure cultures were subjected to WGS.…”

“…Atherosclerosis is the number one cause of morbidity and mortality worldwide. This high incidence of atherosclerosis is not fully explained by conventional risk factors (1). While numerous hypotheses have been proposed for this chronic condition, it is widely accepted to be driven by an inflammatory process.…”

Clinical Evaluation of Patients Suffering From Rheumatoid Arthritis With Respect to Iron Deficiency

“…[4] People with RA are more prone to atherosclerosis, and risk of myocardial infarction (heart attack) and stroke is markedly increased. [6] Other possible complications that may arise include: pericarditis, endocarditis, left ventricular failure, valvulitis and fibrosis. [7] Many people with RA do not experience the same chest pain that others feel when they have angina or myocardial infarction.…”