Abstract
Background
Although the association between autoimmune rheumatic diseases and atherosclerotic
cardiovascular disease is well-known, there is a lack of data regarding the role of
such disorders in patients with premature and extremely premature atherosclerotic
cardiovascular disease.
Methods
The Veterans With Premature Atherosclerosis (VITAL) registry, including patients with
premature (males <55 years, females <65 years) and extremely premature atherosclerotic
cardiovascular disease (<40 years), was created from the 2014-2015 nationwide Veterans
Affairs (VA) health care system database. We assessed age at the time of first cardiovascular
event to compare patients with premature (n = 135,703) and those with extremely premature
atherosclerotic cardiovascular disease (n = 7716) with age-matched patients without
atherosclerotic cardiovascular disease (nyoung = 1,153,535, nextremely young = 441,836). We assessed whether systemic lupus erythematosus, rheumatoid arthritis,
psoriatic arthritis, and ankylosing spondylitis were independently associated with
premature and extremely premature atherosclerotic cardiovascular disease.
Results
Patients with premature and extremely premature atherosclerotic cardiovascular disease
had a higher prevalence of all rheumatic diseases as compared with age-matched patients
without atherosclerotic cardiovascular disease. In fully adjusted models, systemic
lupus erythematosus (odds ratio [OR]: 1.69, 95% confidence interval [CI]: 1.56-1.83)
and rheumatoid arthritis (OR: 1.72, 95% CI: 1.63-1.81) were associated with increased
odds of premature atherosclerotic cardiovascular disease. Patients with systemic lupus
erythematosus (OR: 3.06, 95% CI: 2.38-3.93) and rheumatoid arthritis (OR: 2.39, 95%
CI: 1.85-3.08) also had a higher likelihood of extremely premature atherosclerotic
cardiovascular disease.
Conclusion
Patients with systemic lupus erythematosus and rheumatoid arthritis carry higher odds
of both premature and extremely premature atherosclerotic cardiovascular disease.
Future studies are needed to understand the rheumatic disease-specific factors behind
the development and progression of clinical atherosclerotic cardiovascular disease
in these young patients.
Keywords
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Article Info
Publication History
Published online: June 26, 2020
Footnotes
Funding: This work was supported by a Department of Veterans Affairs Health Services Research & Development Service Investigator Initiated Grant (IIR 16–072), an American Heart Association Beginning Grant-in-Aid (14BGIA20460366), the American Diabetes Association Clinical Science and Epidemiology award (1-14- CE-44), and the Houston VA Health Services Research & Development Center for Innovations grant (CIN13-413). Support for VA/CMS data provided by the Department of Veterans Affairs, VA Health Services Research and Development Service, VA Information Resource Center (Project Numbers SDR 02-237 and 98-004).The opinions expressed reflect those of the authors and not necessarily those of the Department of Veterans Affairs or the US government.
Conflicts of Interest: KN reports research support by Katz Academy of Translational Research and serves on the advisory board for Amgen, Esperion, and Novartis. CMB reports grant and research support paid to institution from Akcea, Amgen, Esperion, Novartis, Regeneron, Sanofi-Synthelabo, National Institutes of Health, American Heart Association, and American Diabetes Association and serves as a consultant for Abbott Diagnostics, Akcea, Amarin, Amgen, Arrowhead, Astra Zeneca, Corvidia, Denka Seiken, Esperion, Intercept, Matinas BioPharma Inc, Merck, Novartis, Regeneron, and Sanofi-Synthelabo. SSV reports honorarium from the American College of Cardiology (Associate Editor for Innovations, aacc.org) and serving on the Steering Committee, Patient and Provider Assessment of Lipid Management (PALM registry) at the Duke Clinical Research Institute, with no financial remuneration. DM, AG, DJR, MAR, AM, CK, MTL, ZS, RSB, HJ, LAP report none.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
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Published by Elsevier Inc.
