Premature Atherosclerosis in Autoimmune Rheumatic Diseases Save

The VITAL study is a VA registry that has shown that both systemic lupus erythematosus  (SLE) and rheumatoid arthritis (RA) patients carry higher odds of both premature and extremely premature atherosclerotic cardiovascular disease and its consequences.

The VITAL registry was established to study patients with premature (males <55yrs, females <65yrs) and extremely premature atherosclerotic cardiovascular disease (<40yrs), to assess risk of first cardiovascular event (CVE). The study included premature (n=135,703) and those with extremely premature atherosclerotic cardiovascular disease (n=7,716) with age-matched control patients without atherosclerotic cardiovascular disease (nyoung=1,153,535, nextremely young=441,836).

The assess CVE risk in those who also had SLE (n=6219), RA (n=11,531), psoriatic arthritis, or ankylosing spondylitis.

Oveall, patients with premature and extremely premature atherosclerotic cardiovascular disease had a higher prevalence of all rheumatic diseases as compared to age-matched patients without atherosclerotic cardiovascular disease.

SLE patients had a higher risk of premature atherosclerotic cardiovascular disease (OR:1.69, 95% CI:1.56-1.83) and extremely premature atherosclerotic cardiovascular disease (OR:3.06, 95% CI:2.38-3.93). 

RA patients had a higher risk of premature atherosclerotic cardiovascular disease  (OR:1.72, 95% CI:1.63-1.81)  and extremely premature atherosclerotic cardiovascular disease (OR:2.39, 95% CI:1.85-3.08).

CV risk was not elevated in PsA (OR 1.09; 0.98-1.21) and AS (OR 0.97; 0.86-1.11) patients. 

Given the increased risk of early-onset atherosclerotic cardiovascular disease, independent of traditional atherosclerotic risk factors, primary prevention should be an objective in RA and SLE patiens. It is unclear what the rheumatic disease-specific factors are that promote the development and progression of atherosclerotic cardiovascular disease in these patients.