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Original research
Similar progression of carotid intima–media thickness in 7-year surveillance of patients with mild SLE and controls, but this progression is still promoted by dyslipidaemia, lower HDL levels, hypertension, history of lupus nephritis and a higher prednisolone usage in patients
  1. Sofia Ajeganova1,2,
  2. Thomas Gustafsson3,
  3. Linnea Lindberg3,
  4. Ingiäld Hafström1 and
  5. Johan Frostegård4
  1. 1 Division of Gastroenterology and Rheumatology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden
  2. 2 Clinical Sciences, Rheumatology Division, Vrije Universiteit Brussel, Brussels, Belgium
  3. 3 Division of Clinical Physiology, Department of Laboratory Medicine and Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
  4. 4 Section of Immunology and Chronic Disease, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Dr Sofia Ajeganova; sofia.ajeganova{at}


Objective To compare progression of subclinical atherosclerosis and factors promoting it in patients with SLE and controls.

Methods Consecutive patients with SLE and age-matched, sex-matched population controls from the SLEVIC cohort were assessed at inclusion and after 7 years with standardised data collection and carotid ultrasound. Effect of risk factors on carotid intima–media thickness (cIMT) progression was examined with adjusted linear mixed models.

Results A total of 77 patients and 74 controls, 68% and 61% of the original cohort, completed follow-up. The patients were (mean) 47 years old, 90% were women, and controls were 51 years old, 92% women. Patients had disease duration of (mean) 11 years, mild disease activity and low severity at both assessments. Baseline cIMT did not differ between the groups. An average absolute cIMT progression was 0.009 mm/year in patients and 0.011 mm/year in controls, intergroup difference p=0.9.

Of factors at inclusion, dyslipidaemia, lower levels of high-density lipoprotein (HDL) and carotid plaque in patients and controls, and higher systolic blood pressure, total cholesterol:HDL and LDL:HDL ratios and triglycerides in patients were associated with cIMT progression. Of factors at follow-up, hypertension and blood lipids in patients and HDL in controls were significantly associated with cIMT progression. History of lupus nephritis and a higher average dose of prednisolone used since diagnosis were associated with cIMT progression in patients. Associations of risk factors with cIMT progression were stronger in presence of plaques.

Conclusion We observed a statistically comparable progression of cIMT in patients with mild SLE and controls over 7 years, which implies that progression of subclinical atherosclerosis in some patients with SLE could follow that of the general population. Traditional cardiovascular (CV) risk factors, history of lupus nephritis and higher use of corticosteroids promote cIMT progression in SLE. Detection of carotid plaque may add to CV risk stratification.

  • systemic lupus erythematosus
  • cardiovascular risk factors
  • carotid atherosclerosis

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  • Contributors IH, JF and SA designed the study. SA was responsible for acquisition of the data, analysis, interpretation of the data and drafting the manuscript. TG was responsible for the carotid ultrasound investigations and LL performed it. All authors participated in interpretation of the data and approved the final manuscript.

  • Funding This study was supported by The Swedish Rheumatism Association, The Swedish Heart Lung foundation, King Gustav V’s 80-year fund, 6th Framework Program of the European Union (grant LSHM-CT-2006-037227 CVDIMMUNE) with JF as co-ordinator.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval The study was approved by the local ethics committee and was performed in accordance with the declaration of Helsinki.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No additional data are available.

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