Background and aims Women with SLE have an increased risk of atherosclerosis that is not adequately explained by traditional risk factors. We previously discovered that a “high risk” score on a panel of biomarkers, PREDICTS, confers 28-fold increased odds for carotid plaque in SLE women, and is also associated with IMT progression. The biomarkers included are pro-inflammatory HDL, sTWEAK ≥373 pg/mL, homocysteine ≥12 mmol/L, leptin ≥34 ng/dL, age ≥48 years, and DMII. It is unknown, however, whether these biomarkers are modifiable by SLE disease modifying agents.

Methods This prospective observational study included UCLA cohort patients started on new immunosuppressive agents. Plasma samples were taken at baseline and 12 weeks. HDL antioxidant function was measured by changes in fluorescence intensity of a substrate incubated with LDL and patient HDL. Plasma leptin and sTWEAK were measured using ELISA. Homocysteine was measured in the UCLA clinical labs.

Results 16 subjects started mycophenolate mofetil (MMF), 18 azathioprine (AZA), and 25 hydroxychloroquine (HCQ). In MMF treated subjects, HDL function (p=0.009, paired t-test) and sTWEAK (p=0.05) significantly improved after 12 weeks, while leptin and homocysteine did not significantly change. In HCQ treated subjects, HDL function improved (p=0.05). In the AZA group there were no significant changes in any of the biomarkers. Overall, the mean number of PREDICTS biomarkers at week 12 significantly decreased in the MMF group (p=0.03).

Conclusions The mean number of “high-risk” cardiac biomarkers significantly improved after initiation of MMF. Further longitudinal studies will determine whether changes in biomarkers reflect decreased cardiovascular events.