# Depression, anxiety, and post-traumatic stress disorder in association with cardiovascular disease among patients with systemic lupus erythematosus and rheumatoid arthritis in the All of Us Research Program

## TL;DR

People with rheumatoid arthritis or lupus who also have mental health issues like depression face higher heart disease risks compared to those with only one condition.

## Contribution

This study reveals the combined impact of mental health conditions and autoimmune diseases on cardiovascular risk in a large US cohort.

## Key findings

- Patients with RA/SLE and mental health conditions had the highest CVD risk compared to those with only one condition.
- Adjusting for sociodemographic factors and comorbidities reduced the observed CVD risk.
- No significant interactions were found between mental health conditions and RA/SLE in influencing CVD risks.

## Abstract

Both mental health conditions, such as depression, anxiety, and post-traumatic stress disorder (PTSD), and cardiovascular disease (CVD) events are increased in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). We assessed associations and interactions between mental health conditions, RA and/or SLE (RA/SLE), and CVD risk.

Patients with RA/SLE in All of Us Research Program were matched 1:20 to patients without either. We calculated hazard ratios (HR, 95% confidence intervals) for associations of baseline depression, anxiety, or PTSD with incident CVD, adjusting for socioeconomic and comorbid factors, repeating for RA and SLE separately. We tested for interactions between RA/ SLE and mental health conditions influencing CVD risk.

Among 5,543 patients with RA/SLE, matched to 110,860 patients without RA/SLE, 31.7% vs. 15.2% had mental health conditions. Matching factor-adjusted CVD event HR was the highest among those with RA/SLE and mental health conditions vs. those with neither (2.91, 2.52–3.36). After full adjustment, this decreased to 1.59 (1.37–1.85). While similar associations were observed for RA and SLE, higher risks were among patients with mental health conditions and SLE (2.08, 1.60–2.71) vs. RA (1.41, 1.17–1.70). No statistical interactions between mental health conditions and RA/SLE influencing CVD risks were detected.

In this large US cohort, patients with RA/SLE and mental health conditions had the highest CVD risks compared to those with either condition or none. Strategies are needed to address mental health conditions that contribute to excess CVD risk for patients with RA/SLE.
Key points• Patients with RA/SLE and mental health conditions had the highest CVD incidence, compared to those with either RA/SLE or any of the mental health conditions alone.• Adjustment for sociodemographic factors and comorbidities attenuated this relative CVD risk.• No significant interactions were found between RA/SLE and mental health conditions influencing observed CVD risks.

Key points

• Patients with RA/SLE and mental health conditions had the highest CVD incidence, compared to those with either RA/SLE or any of the mental health conditions alone.

• Adjustment for sociodemographic factors and comorbidities attenuated this relative CVD risk.

• No significant interactions were found between RA/SLE and mental health conditions influencing observed CVD risks.

The online version contains supplementary material available at 10.1007/s10067-026-07942-1.