Comparative Risks of Cardiovascular Disease in Systemic Lupus Erythematosus, Diabetes and General Medicaid Patients.

OBJECTIVE Cardiovascular disease (CVD) risk is elevated in patients with systemic lupus erythematosus (SLE) and diabetes mellitus (DM), but whether CVD risk in SLE is as high as in DM is unknown. We compared CVD risks between SLE, DM, and general population U.S. Medicaid patients. METHODS In a cohort study, we identified age-and-sex matched (1:2:4) adults with SLE, DM or general population from Medicaid Analytic eXtract (MAX), 2007-2010. We collected baseline sociodemographic factors, comorbidities, and medications. Cox regression models calculated hazard ratios (HRs) of hospitalized non-fatal CVD events (combined myocardial infarction [MI] and stroke), and MI and stroke separately, accounting for competing risk of death and adjusting for covariates. We compared risks in age-stratified models. RESULTS We identified 40,212 SLE, 80,424 DM, and 160,848 general population patients, of whom 92.5% were female, with mean age of 40.3 (±12.1) years. Non-fatal CVD incidence rate per 1,000 person-years was 8.99 for SLE, 7.07 for DM, and 2.36 for general population. Non-fatal CVD risk was higher in SLE compared to DM (HR 1.27 [95% CI 1.15-1.40]), driven by excess risk at ages 18-39 (HR 2.22 [95% CI 1.81-2.71]). SLE had higher CVD risk compared to the general population (HR 2.67 [95% CI 2.38-2.99]). CONCLUSION SLE patients had 27% higher risk of non-fatal CVD events compared to age-and sex-matched DM patients and over twice the risk of the Medicaid general population. The highest relative risk occurred at ages 18-39. These high risks merit aggressive evaluation for modifiable factors and research to identify prevention strategies.