Background/Purpose:

Cardiovascular disease (CVD) is highly prevalent among African American (AA) women diagnosed with systemic lupus erythematosus (SLE). Studies have suggested that CVD risk factors in AA women are different from that experience by other ethnic groups. However little is known regarding the perceptions or barriers and facilitators in reducing CVD risk factors among this population.  The objective of this study was to assess perceptions of modifiable risk factors for CVD and to evaluate the barriers and facilitators to implementing any lifestyle changes needed to reduce CVD risk.  

Methods:

Eight AA women with SLE participating in a longitudinal observational registry (SLE in Gullah Health (SLEIGH) were invited to participate in this study.  After informed consent was obtained, a formative, qualitative study using a focus group format was conducted, audio taped, transcribed verbatim and entered into a qualitative text management software program (NVIVO) to facilitate analysis.  Transcript content was evaluated in relation to perception of CVD risk factors with a diagnosis of lupus and barriers to lifestyle changes in reducing CVD risk factors.  Participants completed questionnaires on sociodemographics and CVD risk factors. Duration of SLE and disease activity was obtained as part of the SLEIGH registry.

Results:

Participant characteristics are displayed in Table 1.  The total prevalence of CVD risk factors among this population was 86%, 50% accounting for family history of CVD before age 55.  Significant themes (Table 2) included lack of education and awareness along with ineffective patient-clinician communication.  Barriers included physical and psychosocial limitations in adopting healthier behaviors.  

Table 1: Patient demographics and disease characteristics

Number of participants (% female)	8 (100%)
Mean age in years	45  (range 19-65)
Highest Education (>12 years)	8 (100%)
Yearly Income (under 10,000)	4 (50%)
Family history of CVD before age 55	4 (50%)
Personal History of CVD  with SLE	3 (37.5%)
Disease duration of SLE in years	20.6   (range 12-39)
Median Disease Severity (SLICC scores)	2 ( range 0-4)

 Table 2:  Five key themes identified with examples 

THEMES	QUOTES
A need for more information and awareness about CVD risk	“Yes.  I think it would be real beneficial.  You would have the awareness and the knowledge to know what to look for.”
A desire for healthcare providers time, attention and communication regarding CVD risk factors	“Because when you get a diagnosis like lupus, you already think your life is over and I just think that they have to know how to present the information in order for the patient to really understand yes you are at risk but I mean you can do things to prevent this and as it stands right now, in my experience and I don’t know what kind of experience you guys have had but like my doctor basically told me my life was over.”
Physical and psychosocial limitations related to the impact of lupus	“Doing things that I used to do is limited now, very, very limited”
The need for effective prevention and disease management approaches	“Well I’ve never been offered screening so if it was offered to me, [crosstalk], then I would go    through the process but I mean it’s never been offered to me.”
Adoption of healthier living habits (activity and diet)	“I can add to what she’s saying.  You eat more whole food.  If you can pick it off a tree or pull it out of the ground eat that.” “Aquatic therapy.  I’ve been doing that for about maybe four or five years.  Aquatic therapy seems to help.”

Conclusion:                                                                                        

This study provides additional data illustrating the importance of patient-clinician communication and the obstacles of effective management in reducing CVD risk.  These findings suggest the need for further exploration of interventions used to eliminate barriers and foster facilitation in reducing CVD risk factors in the presence of SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/perceptions-regarding-cardiovascular-risk-factors-and-barriers-to-risk-reduction-among-african-american-women-with-lupus/