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High-risk coronary plaque in SLE: low-attenuation non-calcified coronary plaque and positive remodelling index
  1. George Stojan1,
  2. Jessica Li1,
  3. Matthew Budoff2,3,
  4. Armin Arbab-Zadeh4 and
  5. Michelle A Petri5
  1. 1Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
  2. 2Cardiology, David Geffen School of Medicine, Los Angeles, California, USA
  3. 3Cardiology, UCLA, Los Angeles, California, USA
  4. 4Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
  5. 5Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
  1. Correspondence to Dr George Stojan; gstojan1{at}


Background Positive remodelling index and presence of low-attenuation non-calcified plaque (LANCP) are characteristic vessel changes in unstable coronary plaques. We sought to characterise these high-risk plaque features in patients with systemic lupus erythematosus (SLE) and to compare them with controls.

Methods A total of 72 patients who satisfied the SLICC classification criteria for SLE had coronary CT angiography (CCTA) studies, 30 of which had follow-up CCTA, as screening for occult coronary atherosclerotic disease in asymptomatic individuals. A total of 100 consecutive controls with no known history of lupus, heart disease or revascularisation who had two coronary CT angiograms at least 1 year apart were included in the study. These were asymptomatic patients referred by their primary physicians for screening of coronary artery disease and the screening interval was decided by the primary physicians. The methodology for image acquisition was identical.

Results LANCP burden at baseline was significantly greater in patients with SLE compared with controls. LANCP volume was significantly greater in patients over 60 years of age (p<0.05) and in those with current prednisone dose >10 mg/day. LANCP burden remained stable over follow-up. There were no significant differences in remodelling index compared with controls.

Conclusion This is the first study describing high-risk CCTA features of coronary plaque in patients with SLE. Both LANCP and positive remodelling are common in SLE. These characteristic vessel changes may identify patients with SLE at increased risk of cardiovascular events and those in need for more frequent cardiac monitoring.

  • lupus erythematosus, systemic
  • atherosclerosis
  • cardiovascular diseases

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  • Contributors All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be published. GS had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study conception and design: GS. Acquisition of data: GS, MAP, AA-Z, MB. Analysis and interpretation of data. GS, MAP, JL.

  • Funding The Hopkins Lupus Cohort is supported by a grant from the National Institute of Health (NIH AR 43727 and 69572). This publication was also made possible by Grant Number UL1 RR 025005 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. GS is a Jerome L. Greene Foundation Scholar.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

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

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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