Comparable Risk for Atherosclerosis in Antiphospholipid Syndrome and Diabetes

The risk for development of subclinical atherosclerotic plaques in carotid and femoral arteries is comparable between patients with antiphospholipid syndrome (APS) and those with diabetes mellitus (DM), according to the results of a recent multiple-group, case-control Greek study published in Seminars in Arthritis and Rheumatism.

The investigators evaluated ultrasonographic markers of subclinical atherosclerosis in the carotid and femoral arteries of 86 patients with thrombotic APS (43 with primary APS [PAPS] and 43 with systemic lupus erythematosus [SLE]-associated APS [SLE-APS]), 86 patients with DM, and 86 healthy control patients. All participants were matched for age and sex.

Carotid plaques were detected in 28% of patients with PAPS, 23% of those with SLE/APS, and 30% of participants with DM compared with 9% of control patients (P =.006). Femoral plaques were identified in 33% of patients with PAPS, 19% of individuals with SLE/APS, and 20% of those with DM compared with 9% of control patients (P =.032). After adjusting for age, sex, hypertension, dyslipidemia, smoking, body mass index, and family history of coronary disease, multivariate regression-derived relative risk (RR) estimates revealed significantly higher numbers of carotid and femoral and atherosclerotic plaques in those with PAPS (RR=2.72; P =.004), in patients with SLE/APS (RR=2.62; P =.009), and in those with DM (RR=1.98, P =.032).

In patients with APS, the presence of atherosclerotic plaques was significantly associated with the number of traditional cardiovascular disease risk factors both in those with PAPS (RR=2.75; P< .001) and in those with SLE/APS (RR=1.84; P <.001), as well as with immunoglobulin G anti-beta2-glycoprotein 1 antibodies in participants with SLE/APS.

The investigators concluded that patients with PAPS and SLE/APS have an almost 2.5-fold risk for development of atherosclerotic plaques in carotid and femoral arteries compared with healthy control patients, a risk that is similar to that in patients with DM. Well-designed longitudinal studies are warranted to evaluate the prognostic significance of subclinical atherosclerotic lesions in those with APS and to assess the benefits of using preventive strategies.

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Reference

Kravvariti E, Konstantonis G, Tentolouris N, Sfikakis PP, Tektonidou MG. Carotid and femoral atherosclerosis in antiphospholipid syndrome: Equivalent risk with diabetes mellitus in a case-control study [published online October 23, 2017]. Semin Arthritis Rheum. doi:10.1016/j.semarthrit.2017.10.015.