Noninvasive imaging can predict future vascular events in SLE

[Guest guest]

Rheumawire

May 11, 2004

Noninvasive imaging can predict future vascular events in SLE

New York, NY - Noninvasive imaging of vascular disease in carotid

arteries of systemic lupus erythematosus (SLE) patients may help predict

future vascular events and aid in risk stratification, according to new

research presented here at the 7th International Congress on Systemic

Lupus Erythematosus and Related Conditions [1].

In the new study of 289 women from the Pittsburgh Lupus Registry, mean

intima media thickness (IMT) was an " incredibly strong predictor " of

future vascular events, says lead researcher Dr Manzi (University

of Pittsburgh, Pittsburgh, PA). Specifically, patients who had an event

had a mean IMT thickness of 0.79 mm, compared with 0.69 mm in those who

did not have an event.

" In addition to such traditional risk factors as age, hypertension, and

SLE-related factors, noninvasive measurement of vascular disease in the

carotid artery may become important in predicting future vascular events

and may help to risk-stratify patients, " Manzi says. The full study

results are slated for presentation at the American College of

Rheumatology later this year.

At baseline, researchers assessed traditional risk factors, SLE-related

markers, and performed a B-mode carotid artery ultrasound on SLE

patients. From July 1995 through January 2004, Manzi and colleagues

identified all patients with a new cardiovascular event and looked at

what baseline risk factors were predictive of risk for myocardial

infarction (MI), angina, transient ischemic attack (TIA), coronary

artery bypass grafting (CABG), or other cardiac events.

Of the original cohort, 18 were lost to follow-up and 41 were excluded

due to prior cardiovascular event, Manzi reported. For the remaining 230

patients, there was a mean follow-up of 5.7 years, or 1264.9 total

person-years of follow-up, resulting in 16 events. In the study, mean

age at event was 56.9 years, and 75% of patients who had an event were

under 60 years old at the time of the event. Mean time to event was 3.47

years, the study showed.

In addition to greater IMT thickness, those patients who had an event

had higher triglycerides than those who did not155.5 mg/dL vs 100.0

mg/dL, respectivelyand lower fasting glucose levels.

While there was no difference in inflammatory markers, Manzi

acknowledged that the small numbers in the study limited its power. The

only SLE-related difference was double-stranded DNA-positive status.

In a related study of 153 SLE patients that used B-mode ultrasound

examination of both carotid arteries, high-sensitivity C-reactive

protein (CRP) was a strong predictor of coronary calcium, as were

homocysteine levels [2].

" This study strongly suggests that dietary modification for

hyperlipidemia will not be sufficient for atherosclerosis prevention in

SLE, " conclude researchers, led by Dr Adnan Kiani (s Hopkins

University School of Medicine, Baltimore, MD).

" We hypothesize that statins, which have anti-inflammatory effects, may

be beneficial, " they write. " Measurement of CRP may identify SLE

patients at greater risk for accelerated atherosclerosis, who can be

targeted for noninvasive monitoring. "

Age and systolic blood pressure are predictors of carotid IMT; however,

there was only a mild correlation between coronary calcium score and

IMT, Kiani reports.

" We have been very successful in prolonging survival in patients with

lupus, " says Dr Murray Urowitz (Toronto Western Hospital, ON).

In fact, he says, the good news is that 70% to 75% of lupus patients

have at least a 20-year survival. " The less good news is the fact that

lupus patients still die 2 times more frequently when compared with

age-matched controls " namely due to cardiovascular disease.

Using data from the Toronto Risk Factors study [3], Urowitz and

colleagues compared lupus patients with events with lupus patients

without events.

" In the short term, in lupus patients with no history of an

atherosclerotic vascular event, individual risk factors are not

predictive of atherosclerotic vascular events, but they are when

compared with healthy controls, and [thus] " all modifiable risk factors

should be addressed in patients with lupus. "

" The most common cause of death in lupus is accelerated

atherosclerosis, " congress chair Dr G Lahita (Jersey City Medical

Center, Jersey City, NJ) tells rheumawire. " Immunologically, there has

to be a link between atherosclerosis and autoimmunity. "

Accelerated atherosclerosis " may really be an autoimmune disease, so the

secrets of lupus are an attempt to uncover secrets of accelerated

atherosclerosis, " he says.

Mann

Sources

1. Kiani A, Post W, Petri M. Presentation: Risk factors for subclinical

atherosclerosis in SLE. New York, NY: 7th International Congress on

Systemic Lupus Erythematosus and Related Conditions: Session on

long-term outcome: heart and vessels; May 9-13, 2004:NA.

2. Kiani A et al. Presentation: Session on long-term outcome: heart and

vessels. : New York, NY: 7th International Congress on Systemic Lupus

Erythematosus and Related Conditions; May 9-13, 2004:NA.

3. Bruce IN, Urowitz MB, Gladman DD, Ibanez D, Steiner G. Risk factors

for coronary heart disease in women with systemic lupus erythematosus:

the Toronto Risk Factor Study. Arthritis Rheum 2003 Nov; 48(11):3159-67.

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org