Background Effect of classical risk factors on progression of subclinical atherosclerosis in patients with SLE in comparison with population controls is not clear. We aimed to compare progression of carotid intima-media thickness (cIMT) and factors promoting it in patients with SLE and controls.

Methods Patients with SLE and matched population controls from the SLEVIC-cohort were assessed at inclusion and after seven years with standardized data collection and carotid ultrasound. Effect of risk factors on 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% females, controls were 51 years old, 92% females. Patients had disease duration of mean 11 years and mild disease activity. 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. Dyslipidemia and hypertension at both assessments and carotid plaque at inclusion were associated with cIMT progression in patients and controls. 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 was stronger in presence of plaques.

Conclusions We observed similar progression of cIMT in SLE and controls over 7 years, which implies that progression of subclinical atherosclerosis in some patients with SLE could be normalized. Traditional 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.