Background SLE patients have 5–10-fold increased risk of developing CVD compared to controls.1,2 In this study we aimed to describe the rate and determinants of carotid plaque progression in a cohort of SLE patients who were asymptomatic of CVD at baseline.
Methods Vascular ultrasound studies of 100 patients with SLE asymptomatic of CVD was carried out at baseline. Sixty-nine patients were rescanned (94% female, mean overall age 46 years (SD 11)) over a median of 5 years of follow up. Clinical and CVD risk was assessed at baseline and follow up. B-mode Doppler ultrasound was used to measure intimal media thickness and plaque to assess progression. Total plaque area (TPA), a more sensitive measure of plaque, and echolucency expressed as gray scale median (GSM), linked to plaque lipid content were assessed.
Results Of the 100 patients with a baseline scan, 69 patients had a second scan at a median of 5 years follow up. New plaque developed in 9% and 26% had an increase in plaque number. The mean overall IMT (0.111 vs 0.064, p<0.01) and common carotid IMT (0.065 vs 0.055, p<0.01) were significantly raised in plaque vs non-plaque patients. In a multi -variable analysis CIMT at follow-up was independently associated with age (beta 0.415, p<0.001) and diastolic blood pressure (beta 0.285, p<0.021). Independent predictors of plaque at follow-up scan on multi-variable analysis were age at scan>52 years (OR 10.41, CI 2.66–40.80) and systolic BP>133 (OR 5.26, CI 1.396 – 19.862). In contrast, total cholesterol was negatively correlated with TPA (beta =-1.167, p=0.002) and with GSM (beta =-0.513, p=0.012).
Conclusions Amongst these 69 patients, 26% had progression and none had decreased plaque over a median of five years follow-up. Measurement of novel ultrasound variables such as TPA and echolucency may identify more modifiable risk factors that can be used to improve CVD outcomes in patients with SLE.
Acknowledgements Rosetrees Trust
Bruce IN. ‘Not only...but also’: factors that contribute to accelerated atherosclerosis and premature coronary heart disease in systemic lupus erythematosus. Rheumatology (Oxford, England) 2005;44(12);1492–502.
Manzi S, Meilahn EN, Rairie JE, et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol 1997;145(5);408–15.
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