Telomere length predicts mortality in the Black Women’s Experiences Living with Lupus (BeWELL) Study

Abstract

Systemic lupus erythematosus (SLE) is a chronic autoimmune disease marked by inflammation that disproportionately impacts Black women. Telomeres are repetitive sequences of DNA capping the ends of chromosomes that shorten more rapidly in response to inflammation. Studies suggest that the telomere maintenance system may be disrupted in those with SLE, who have been shown to have shorter telomeres compared to healthy controls. Among those with SLE, Blacks have been found to experience more accelerated telomere shortening compared to those of other race groups. We examined the relationship between telomere length (TL) and mortality using data from the Black Women’s Experiences Living with Lupus (BeWELL) Study. Participants were 438 Black women with a validated diagnosis of SLE living in the Atlanta, Georgia metropolitan area, recruited between April 2015 and May 2017 predominantly from a large population-based registry. TL was assayed from dried blood spots collected at baseline and measured as the relative telomere to single copy gene (T/S) ratio. Mortality was assessed prospectively through April 2019. A total of 24 participants died during this time period. There was a negative association between TL and mortality, with shorter TL being associated with greater mortality risk (hazard ratio = 0.01, p=0.02). This relationship remained statistically significant after controlling for age and years since diagnosis, and further adjustment for a range of socio-demographic and health-related factors, including SLE damage and activity. Findings suggest that TL may forecast mortality among Black women with SLE. The association between TL and mortality among people with SLE should be further explored.