Asymptomatic Coronary Artery Disease More Prevalent in Those With vs Without SLE

Patients with vs those without systemic lupus erythematosus (SLE) have an increased prevalence, but not severity, of asymptomatic coronary artery disease (CAD), as measured by computed tomography (CT) angiography, according to study findings published in European Journal of Internal Medicine.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients with SLE, though current models do not effectively predict CV risk. Researchers have determined CT angiography to be a reliable method of measuring coronary artery calcium, which may be indicative of cardiovascular risk.

In a systematic literature review and meta-analysis, authors included randomized and nonrandomized controlled studies published through January 2021. Eligible studies reported the prevalence and magnitude of CAD using coronary calcium scores in patients without history of heart disease or stroke. Patient demographic information, clinical variables, diagnostic method of CAD, and angiographic data were collected from each study.

It was noted that CAD was defined as a coronary calcium score of greater than zero. The prevalence of CAD was calculated using random effects modeling of pooled data. Mean coronary calcium scores with standard deviations were pooled to estimate the weighted mean difference between patients with SLE and control participants.  

The CAD prevalence was calculated in 11 studies (n=918 with SLE and n=3952 control participants). The risk for CAC was 29.8% in patients with SLE compared with 11.8% in control participants (risk ratio, 2.22; 95% CI, 1.42-3.48; P =.0005). Seven studies contributed to the analysis of mean coronary calcium scores. No significant difference was noted in the severity of CAD in patients with SLE compared with control participants (mean coronary calcium score difference, 0.32; 95% CI, -5.55 to 6.20; P =.91).

In 2 studies, SLE disease factors, including greater organ damage and higher glucocorticoid use, were associated with the presence or progression of CAD. Two other studies indicated an increased calcified and noncalcified plaque burden in patients with SLE compared with control participants.

Study limitations included in the meta-analysis were the small sample size, statistical heterogeneity, cross-sectional design, and lack of pediatric study participants. In addition, most studies included patients with SLE who were receiving medications (glucocorticoids, hydroxychloroquine, and statins) that are known to reduce CV risk. The studies did not adjust for other CVD risk factors, such as depression and physical inactivity, which are common in patients with SLE.

The study authors concluded, Studies should focus on the longitudinal analysis of CAD assessed by CT and its relationship with injury markers, lipid function, and immune cells to understand inflammatory atherosclerosis and the effects of anti-inflammatory therapies.”

Reference

Mendoza-Pinto C, Munguía-Realpzo P, García-Carrasco M, et al. Asymptomatic coronary artery disease assessed by coronary computed tomography in patients with systemic lupus erythematosus: a systematic review and meta-analysis. Eur J Intern Med. Published online April 8, 2022. doi:10.1016/j.ejim.2022.04.001