Cardiovascular disease (CVD) causes a quarter of deaths in patients with SLE and imaging studies show that patients with SLE have a higher prevalence of asymptomatic atherosclerotic plaques than age and sex-matched controls. It is not yet clear how strongly presence of these plaques influences the risk of developing CVD subsequently in patients with SLE.
Between 2011–2013, we carried out vascular ultrasound studies of 100 SLE patients, who had no known history of previous CVD. 95% were women and the mean age was 45.2 years. Thirty-six patients had plaque which included 14 with only carotid plaque, 7 with only femoral plaque and 15 with both. This follow-up study describes subsequent onset of CVD in these 100 patients.
The medical records of all 100 scanned patients were reviewed. CVD event were defined as coronary artery disease, peripheral vascular disease and cerebrovascular disease. Where CVD was diagnosed, it was corroborated by relevant blood tests and imaging. We carried out statistical analysis of associations between baseline variables at the time of the scan and risk of developing CVD subsequently.
From the 100 patients scanned, 7 patients were subsequently found to have CVD. Demographic information of these patients is shown in table 1. All the events occurred within a 4 year period from the initial scans. CVD occurred in 6/36 patients with plaque compared to 1/64 without plaque (p=0.002). The average number of plaque sites was 2.4 (CVD patients) compared to 0.7 (p=0.02) in those without CVD. CVD was also significantly associated with age at scan (p=0.02) and mean intima-media thickness (p=0.01). There were no significant associations with gender (p=0.5), ethnicity (p=0.2), smoking status (p=0.6), high blood pressure (p=0.7), persistent disease activity (p=0.4), HCQ (p=0.6) and prednisolone dose >5 g (p=0.2) at the time of scanning.
This study shows that the presence of plaque was strongly associated with development of CVD within the next four years in this population of patients. Most CVD events were coronary, so not caused directly by carotid plaque. Vascular ultrasound may be helpful in improving management of CVD risk in patient with SLE.
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