Background Cardiovascular disease (CVD) is a leading cause of death in systemic lupus erythematosus (SLE). The coronary artery calcium (CAC) score is a surrogate for atherosclerosis that strongly predicts incident coronary artery disease and major CVD events, independent of traditional risk factors. The prevalence of CAC deposition in SLE patients over the age of 45 is known to be significantly higher compared with the Multi-Ethnic Study of Atherosclerosis (MESA) cohort, however data on patients<45 years of age is scarce. evaluated CAC scores in younger SLE patients, compared with healthy controls from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort.
Methods We identified 76 SLE patients meeting 1997 ACR classification criteria, without known coronary artery disease and who had a non-contrast CT chest performed as part of their clinical care, with images retrievable for calculation of CAC scores, using the Agatston score. Demographics, disease characteristics, and comorbidities were ascertained. Prevalence of any calcification, defined as CAC>0, was reported and compared with data from the CARDIA cohort, a large biracial U.S. cohort of patients ages 33 to 45 at time of chest CT scan for CAC determination. Additionally, within our SLE cohort, we investigated the relationship between disease characteristics and presence of any coronary artery calcification.
Results 76 SLE patients were studied (40±13 years old, 90% female, 33% Hispanic, 40% African American, disease duration 7±6 years). Patients met on average 6±2 ACR-SLE classification criteria; all had positive ANA titers, 64% had elevated dsDNA titers. Average SLE disease severity index1 was moderate at 5±3, 46% had lupus nephritis (LN) and 37% tested positive for antiphospholipid (APL) antibodies. The prevalence of CAC>0 was 42% for patients of all ages, 32% for age <45, 62% for age 45. CAC scores were between 1 and 100 in 72% of the patients and >100 for the remaining 28%. When compared with the CARDIA subjects, more SLE patients ages<45 had a CAC>0 (32.0% vs 9.6%, p-value<0.00001). Additionally, 29% of SLE patients age 18 to 32, with 5 years median SLE disease duration, had abnormal CAC scores; the youngest of whom was 21 years old. SLE patients with CAC were more likely to be older, have a history of a HTN, and have higher BMI. There were no significant differences in SLE disease duration, SLE severity index, APL antibodies, prevalence of LN, or smoking status, between patients with and without CAC.
Conclusions Young SLE patients have a significantly higher CAC scores compared with the general population. A CAC >0 was seen in 32% and 29% of SLE patients<45 and<33 years old, respectively. Our data suggest that subclinical atherosclerosis in SLE develops as early as the second decade of life, and warrant screening and cardio-protective interventions.
Funding Source(s): None
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