A research team at the University of Wisconsin Lupus Clinic discovered that Black patients with lupus face a risk of cardiovascular disease that is 19 times higher than non-Black populations within the first 12 years of their diagnosis.
Led by Director of UW Health Lupus Clinic and Medicine and Public Health professor Dr. Shivani Garg, the study focused on lupus-caused cardiovascular disease by studying several racial groups, with 75% of their research population being Black.
The end goal of the research was to find effective precision medicine methods to address all forms of lupus.
The team wanted to know more about the relationship between cardiovascular disease, lupus and lupus nephritis. Lupus is a systemic autoimmune disease that can affect and inflame any organ in the body, Dr. Garg said. Lupus nephritis is a more specific type of lupus that has focused inflammation in the kidneys.
The study also aimed to reveal racial disparities in lupus outcomes. Dr. Garg led the study along with Department of Rheumatology professor Dr. Christie Bartels.
Garg and her team used a population-based cohort — this means everyone in the study had lupus, which created a rich set of data, Garg said.
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The study found social determinants of health were a main factor in poor outcomes for Black patients. The researchers compared the burden of cardiovascular disease for Black people versus white people.
The social determinants of health studied included easy access to healthcare, economic status, insurance, travel barriers and others, Garg said.
The results indicated that around one-fifth of Black patients have cardiovascular events before white patients have their first, Bartels said. Black patients are having worse health outcomes later on and their decline is happening much faster than white patients. This could be explained by the effects of social determinants on Black patient health.
“This study just opens up the gateway to dive deeper into those social aspects which could be affecting patients’ care,” Garg said. “Then trying to target those as well as implement preventative strategies because help cannot go without holding hands up.”
Garg and her team want to focus on the idea that race is a social construct, not a genetic factor in health, and learn how these social pressures can affect lupus outcomes.
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The study produced similar results to a previous study, Bartels said. Her previous study surveyed a rural Wisconsin cohort, which did not factor in social disparities. With a majority Black cohort for the current study, Bartels and Garg collected important disparity data.
“Precision medicine is when we can improve the risk prediction to an extent and we are able to calculate the risk of having poor outcomes earlier so that we can guide targeted therapies and prevention in those groups,” Garg said, “It will mean that medications can be given based on individual patient risk factors or patient presentation. It doesn’t have to be a one-size-fits-all medication.”
The researchers found a dramatic racial disparity between Black, Hispanic and white patients.
“Lupus is very interesting because there is a nine-to-one ratio of women having lupus compared to men and a three-to-one ratio of women of color having lupus compared to white women,” Bartels said.
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Black patients had cardiovascular events at year two and again around the 10- to 11-year mark, while white patients had their first cardiovascular events around the five-year mark, Bartels said.
Bartels said precision medicine is not just becoming a focus at UW, but nationwide. Other universities and research facilities are beginning to look at preventative healthcare strategies for underserved populations as well.
“[Our] co-authors are already collaborating on other projects to improve prevention of cardiovascular disease risk in patients with lupus, lupus nephritis and other rheumatic diseases, like other universities such as Emory University,” Garg said
Garg said that other medical staff like Bartels are leading studies about early predictors using a common collaborative approach combining data from UW and other research universities.
Bartels said she hopes to work to improve population management and outcomes for patients with lupus in her future research.