The total number of arterial bifurcations containing plaque and total plaque area predicts increased risk for cardiovascular events in patients with systemic lupus erythematosus (SLE), according to study results published in Rheumatology.

Researchers sought to determine how best to manage cardiovascular disease (CVD) risk in patients with SLE, using clinical information obtained via vascular ultrasonography.

Clinical, serologic, demographic data were collected from patients at baseline. A trained vascular imaging specialist examined both carotid and femoral arterial bifurcations, measured the intima media thickness, and determined if plaque affected the arteries (defined by focal thickening of the intima media >1.2 mm). The researchers calculated total plaque area using a software program that analyzed the ultrasound images.


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A total of 100 patients (98 women) with SLE without a prior diagnosis of CVD who received treatment at the Lupus Clinic at University College London Hospital between October 2011 and April 2013 were enrolled in the study with long-term follow-up until December 2020. By the end of the study, 9 patients were lost to follow-up and 3 patients died from noncardiovascular causes. Of the remaining patients, 7 experienced cardiovascular events, including lacunar strokes and coronary events, during the follow-up period.

With the exception of decreased serum levels of complement factor C3, none of the traditional risk factors, such as total cholesterol, HDL- and LDL-cholesterol levels, diabetes, smoking history, systolic blood pressure, current medications, and serum concentration measurements, influenced CVD risk in this study cohort.

A total of 36 patients had plaque at baseline. Total plaque area greater than 16 mm2 (P =.028), 3 or more arterial bifurcations containing plaque (P =.009), and disease duration longer than 14 years (P =.043) were positively associated with CVD risk.

Limitations of the study included the small sample size, failure to collect body mass index (BMI) and cumulative corticosteroid dose at baseline, and lack of generalizability to other patient populations.

The researchers suggested that existing preventive measures to lower blood pressure and cholesterol levels may effectively reduce occurrence of future cardiovascular events in high-risk patients with SLE.

They also stated, “The very strong predictive value of [total plaque area] and number of bifurcations with plaque…leads us to suggest that vascular ultrasound scanning may have a place in assessing CVD risk in patients with SLE.”

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Bakshi J, Croca SC, Griffin M, et al. Extent of vascular plaque predicts future cardiovascular events in patients with systemic lupus erythematosus. Rheumatology (Oxford). Published online April 28, 2022. doi:10.1093/rheumatology/keac259