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

Abstract

ObjectiveTo compare progression of subclinical atherosclerosis and factors promoting it in patients with SLE and controls.MethodsConsecutive 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.ResultsA 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.ConclusionWe 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.

Patients with SLE have higher risk of cardiovascular events and mortality in comparison with controls with the same levels of traditional risk factors and intima-media measures, which is related to accumulated disease damage and antiphospholipid syndrome: a case–control study over 10 years

“…We have, however, shown similar cIMT progression over 7 years in patients with mild SLE and the controls. 43 Carotid plaques could be a stronger marker of atherosclerotic vessel disease and a predictor of clinical events, when compared with cIMT. Interestingly, the plaque progression rate was higher than, and the intima-media thickness progression rate was similar to, those in the control group in the Pittsburgh lupus cohort.…”

High-Frequency Ultrasound of Multiple Arterial Areas Reveals Increased Intima Media Thickness, Vessel Wall Appearance, and Atherosclerotic Plaques in Systemic Lupus Erythematosus

“…Previous studies used US in SLE for both risk assessment and follow-up ( 33 ), but several studies have focused mainly on IMT and the presence of plaques seen in CCA ( 3 , 34 , 35 ). Sporadic studies have evaluated the benefit of US in other vessels ( 36 – 38 ).…”

“…We were not able to estimate accumulated life-time intake of glucocorticoids, but most patients were in quiescent phase of their disease on a stable dose of steroids during the last 6 months. Ajeganova et al observed progression of IMT in CCA among patients with SLE during a 7-year surveillance and showed that traditional risk factors, LN, and higher doses of corticosteroids were associated with the progression of IMT ( 33 ). By comparing the phenotypic subgroups and controls, we found that IMT of ICA, CFA, and the aortic arch was higher in the APS group.…”

Disease activity index is associated with subclinical atherosclerosis in childhood-onset systemic lupus erythematosus

“…Falashi et al evaluated twenty-six cSLE patients and reported that patients with nephrotic-range proteinuria have significantly higher CIMT than those without proteinuria [ 4 ]. History of lupus nephritis and hypertension were correlated with CIMT in a seven-year surveillance in another SLE study that showed no difference in progression of subclinical atherosclerosis between patients with mild lupus and control subjects [ 49 ]. On the other hand, Sharma et al reported no significant differences in CIMT between 102 SLE patients with and without nephritis, although the nephritis group exhibited a higher SLEDAI score, more persistent inflammation and, consequently, higher risk to developed arterial injury leading to early end-organ damage [ 50 ].…”