Increased Risk of Cardiovascular Complications in People with SARDs
Risk of Heart Attack, Stroke and Venous Thromboembolism in People with Systemic Autoimmune Rheumatic Diseases (SARDs)
Dr. J. Antonio Aviña-Zubieta, MD, MSc, PhD Associate Professor of Medicine, University of British Columbia Research Scientist, Arthritis Research Canada BC Lupus Society Scholar Michael Smith Foundation for Health Research Scholar
Why do this research?
Systemic autoimmune rheumatic diseases (SARDs) are a group of rare diseases in which a person’s immune system malfunctions and attacks its own tissues. SARDs include systemic lupus erythematosus (SLE), scleroderma, Sjögren’s syndrome, polymyositis (PM), dermatomyositis (DM), and the systemic vasculitides (granulomatosis with polyangiitis, formerly known as Wegener’s, giant cell arteritis [GCA], polyarteritis nodosa, Takayasu’s arteritis).
Limited research has been done on the risk of cardiovascular complications, which include heart attack, stroke and venous thromboembolism (blood clots in the legs and/or lungs), in people with SARDs. Of those studies that have been done, most are from people seen in specialized clinics where they see the sickest patients; therefore, the exact risk of cardiovascular complications for people with SARDs from the general population is unknown.
The goal of our study is to determine if people with SARDs have an increased risk of developing complications like heart attack, stroke or venous thromboembolism. Changes in risk of developing these complications over time are also being explored.
What will be done?
Using anonymized administrative health data from the British Columbia Ministry of Health, we determined rates of cardiovascular complications in people with all types of SARDs.
To date, what are the key findings?
Patients with SARDs have a significantly increased risk of venous thromboembolism. The risk is increased 7-fold in patients with DM and PM, 2.5-fold in patients with GCA, 3-fold in patients with SLE, and 3.5-fold in patients with scleroderma, compared with the general population. Also, within one year of being diagnosed, patients with SLE have a 13.5 times increased risk of developing venous thromboembolism, while patients with scleroderma have a 12 times increased risk, compared with the general population.
Patients with SARDs also have a significantly increased risk of having a heart attack or a stroke. The risk of a heart attack is increased 2-fold in patients with GCA, 3.5-fold in patients with scleroderma, and 4-fold in patients with DM and PM, compared with the general population. In patients with GCA, the risk of a stroke was also 2 times greater than the general population’s risk; those with scleroderma have a 2.4 times greater risk of stroke. Regardless of the SARD, the risk of having a heart attack or stroke was significantly higher within one year of being diagnosed with a SARD.
These results point to the need for increased screening and monitoring for cardiovascular complications in patients with SARDs, particularly within the first year of diagnosis. Early diagnosis of SARDS followed by rapid treatment is needed to decrease inflammation, which is a risk factor for developing cardiovascular complications.
What’s next? From the SARDs patients included in our previous analyses, we plan to identify those individuals at highest risk of developing cardiovascular complications. We will then determine what the risk factors for cardiovascular complications are amongst these SARDs patients.
Carruthers E, Choi HK, Sayre EC, Aviña-Zubieta JA. Risk of deep venous thrombosis and pulmonary embolism in individuals with polymyositis and dermatomyositis: A general population-based study. Ann Rheum Dis Sept 2014 doi:10.1136/annrheumdis-2014-205800. [Epub ahead of print]
Aviña-Zubieta JA, Bhole VM, Amiri N, Sayre EC, Choi HK. The risk of deep venous thrombosis and pulmonary embolism in giant cell arteritis: A population-based study. Ann Rheum Dis Sept 2014 doi:10.1136/annrheumdis-2014-205665. [Epub ahead of print]
Amiri N, De Vera M, Choi HK, Sayre EC, Aviña-Zubieta JA. Increased risk of cardiovascular disease in giant cell arteritis: A general population-based study. Rheumatology (Oxford). 2015 Aug 5. pii: kev262. [Epub ahead of print].
Aviña-Zubieta JA, Vostretsova K, De Vera M, Sayre EC, Choi HK. The risk of pulmonary embolism and deep venous thrombosis in systemic lupus erythematosus: A general population-based study. Sem Arthritis Rheum 2015 Oct;45(2):195-201.
Rai S, Choi HK, Sayre EC, Aviña-Zubieta JA. Risk of myocardial infarction and ischemic stroke in individuals with polymyositis and dermatomyositis: A general population-based study. Rheumatology (Oxford). 2015 Sep 30. pii: kev336. [Epub ahead of print]
Schoenfeld SR, Choi HK, Sayre EC, Avina-Zubieta JA. The risk of pulmonary embolism and deep venous thrombosis in systemic sclerosis: a general population-based study. Arthritis Care Res (Hoboken). 2015 Jul 20. doi: 10.1002/acr.22673. [Epub ahead of print]
Aviña-Zubieta JA, Man A, Yurkovich M, Huang K, Sayre EC, Choi HK. Early Cardiovascular Disease after the Diagnosis of Systemic Sclerosis. Am J Med 2015 Nov 18. pii: S0002-9343(15)01051-7.
Who is on the research team?
Hyon Choi, MD, DrPH, FRCPC, Professor, Department of Medicine, Massachusetts General Hospital, Harvard Medical School
Lynn Nowoselski, Research Assistant, ARC
Lindsay Belvedere, Research Assistant, ARC
Kathryn Reimer, Research Assistant, ARC
Eric C Sayre, PhD, Statistician, ARC
Lianne Gulka, Arthritis Patient Advisory Board, ARC
Joyce Ma, Arthritis Patient Advisory Board, ARC
Janis McCaffrey, Consumer Advisory Committee, SARDs-ARC
Marilyn Mulldoon, Sjögren’s Society of Canada and Arthritis Patient Advisory Board, ARC
Alan Pemberton, Consumer Advisory Committee, SARDs-ARC
All patient collaborators provided feedback on the conception and design of the study, which was used in developing the funding proposal for this research. Additionally, they provided letters of support for the project, which assisted in obtaining funding.
Canadian Institutes of Health Research, Michael Smith Foundation for Health Research, British Columbia Lupus Society