Connective Tissue Diseases Like Scleroderma, Race and Age Increase Risk for Cardiovascular Disease

New research from the University of Chicago Medical Center indicates that African-Americans with connective tissue diseases, including scleroderma, are twice as likely as Caucasians with the same medical conditions to have specific risk factors for a heart attack, stroke, or cardiovascular-related death. The study, “The Prevalence of Atherosclerosis in Those with Inflammatory Connective Tissue Disease by Race, Age, and Traditional Risk Factors,“ appeared in the Nature journal Scientific Reports.

“These findings raise new questions about the links between inflammation, connective tissue diseases and atherosclerotic cardiovascular disease,” the study’s author, Francis Alenghat, M.D., Ph.D., assistant professor of medicine in cardiology at the University of Chicago, said in a press release. “They point to differences in heart disease risk tied to systemic inflammation and modified by race and age.”

There has been previously been very little information about how connective tissue diseases may differ in different races. Alenghat noted “a dearth of formal understanding on interactions of race with connective tissue diseases in determining cardiovascular risk,” leading him and co-workers to turn to the study of “the large, diverse patient population seen here at the University of Chicago.”

The research study used medical charts and information from 287,000 African-American and Caucasian patients treated at the University of Chicago’s medical center. A total of 10 percent of African-American patients had atherosclerotic cardiovascular disease, compared to 8.4 percent of Caucasian patients. Atherosclerotic cardiovascular disease included heart attack, ischemic heart disease, angina, coronary artery disease or atherosclerotic disease in any artery.

The study included 8,747 patients with some type of connective tissue disease, including scleroderma, lupus, rheumatoid arthritis, inflammatory arthropathy, among others. Overall, people with connective tissue disease had an increased risk of cardiovascular disease, which further increased if they were African-American.

Almost 30 percent of African-Americans with connective tissue disease also had cardiovascular disease. In contrast, 15 percent of Caucasians with connective tissue disease had co-occurring cardiovascular disease. This represented a 1.8 greater incidence than found in Caucasians without connective tissue disease. African-Americans with connective tissue disease also developed cardiovascular disease at a younger age than Caucasians.

“The molecular and cellular causes of each connective tissue disease are distinct,” Alenghat said. “But they all involve systemic inflammation. … we should consider lower thresholds for primary prevention in many patients with CTD [connective tissue disease],” he said.

The study identified risk factors for cardiovascular disease in those with co-occurring connective tissue disease, which could aid in future clinical assessments and diagnosis of both disorders.

Alenghat also believes the findings may guide earlier treatment, saying, “If we were to view the current findings on the backdrop of contemporary cardiovascular risk calculators and statin guidelines, many patients with connective tissue disease could reasonably consider moderate-intensity statin therapy at age 35.”