Predictors of Carotid Atherosclerosis in Systemic Lupus Erythematosus

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Predictors of Carotid Atherosclerosis in Systemic Lupus Erythematosus

Category:  23 SLE‹clinical aspects

K Maksimowicz1, M Petri1, L Magder2

1s Hopkins University School of Medicine, Baltimore, MD;2University of

land, Baltimore, MD

Presentation Number: 32

Poster Board Number: 32

Keywords: Systemic Lupus Erythematosus, Atherosclerosis, Cholesterol

It has been well documented that patients with SLE are at increased risk for

cardiovascular and cerebrovascular events, even after adjustment for

traditional risk factors. We examined the association of traditional risk

factors, novel markers of cardiovascular disease (CRP, homocysteine,

lipoprotein(a), PAI-1, fibrinogen), and markers indicative of SLE activity

(including C3, C4, anti-dsDNA, and prednisone use) with the presence of

significant plaque on carotid duplex studies.

Methods: 622 SLE patients (92% female, 38% African-American) underwent

screening carotid duplex studies. We report the percent with plaque for the

presence or absence of each predictor. For predictors that varied over time,

such as cholesterol, the mean values during cohort participation were

calculated and used in the analysis.

Results: Traditional risk factors associated with plaque include male sex

(25% vs 14%, p = 0.024), family history (p=0.0014), smoking (19% vs 11%,

p=0.002), hypertension (25% vs 5%, p=0.001), LVH (29% vs 15%, p=0.006), high

mean cholesterol (18% vs 10%, p=0.004), and high mean blood glucose (19% vs

8%, p=0.001). The novel risk factor associated with the presence of plaque

was homocysteine (17% vs 14%, p=0.027). We did not find an association with

the presence of antiphospholipid antibodies (aCL, LA by dRVVT). Disease

activity, measured either by a visual analog scale (VAS) or by SLEDAI, was

not associated with carotid plaque. In contrast, we did note an association

between higher mean C3 (18% vs 11%, p=0.003) and mean C4 (18% vs 11%,

p=0.012) with carotid plaque. However, this association disappears after

controlling for age.Conclusion: Hypercomplementemia is associated with

carotid plaque, but represents an increase in complement with age.

Traditional cardiovascular risk factors are also strongly associated with

carotid plaque. These results underscore the importance of early screening

for traditional cardiovascular risk factors and homocysteine, and for

aggressive monitoring and intervention for those SLE patients found to be at

risk.