Predictors of Carotid Intima Media Thickness and Plaque Identified in Women With SLE

Higher fasting glucose and lower fibrinogen levels were found to be potential risk factors for carotid intima media thickness (IMT) progression, while large waist circumference and nonuse of hydroxychloroquine were observed to be associated with increased plaque progression over a period of 5 years in women with systemic lupus erythematosus (SLE), according to study results published in Lupus, Science and Medicine.

Previous studies have shown that SLE is associated with increased subclinical atherosclerosis, including increased carotid IMT and carotid atherosclerotic plaque.

The objective of the current study was to determine the occurrence and potential risk factors for progression of carotid IMT and plaque in patients with SLE during a 5-year follow-up.

The study included adult women from the Chicago Lupus Database with a diagnosis of SLE enrolled in the Study of Lupus Vascular and Bone Long-Term Endpoints (SOLVABLE). B-mode ultrasound was used to measure carotid IMT and plaque at baseline and at the 5-year follow-up.

The study sample included 149 women (mean age, 43.2 years) with SLE and 126 control participants (mean age, 46.6 years) who were followed-up for 5.35 and 5.62 years, respectively.

Mean IMT change per year was 0.008±0.015 mm among women with SLE, and 0.005±0.019 mm among healthy control participants (P =.24). Any increase in IMT at follow-up was recorded for 72.5% of patients and 66.7% of control participants (P =.36). Risk for plaque progression over time was 2-fold increased among women with SLE compared with control participants (31.5% vs 15%; relative risk, 2.09; 95% CI, 1.30-3.37).

Among patients with SLE, increased baseline fasting glucose levels (β=0.5475; 95% CI, 0.1825-0.9124) and lower fibrinogen levels (β=-0.0634; 95% CI, -0.1196 to -0.0072) were associated with progression of carotid IMT; a greater waist circumference was associated with plaque progression.

In multivariate models, greater waist circumference (odds ratio [OR], 1.62; 95% CI, 1.07-2.45) and nonuse of hydroxychloroquine (OR, 0.38; 95% CI, 0.16-0.90) were associated with increased plaque progression.

In the combined analysis of patients and control participants, there was no significant association between the diagnosis of SLE and progression of carotid IMT. However, women with SLE were at an increased risk for plaque progression compared with control participants (adjusted OR, 2.93; 95% CI, 1.49-5.74).

The study had several limitations, including the small sample size, potential limited follow-up time to identify distinct changes in IMT or plaque, potential alterations and fluctuation of risk factors over time, and the limitations associated with B-mode 2-dimensional ultrasound compared with 3-dimensional imaging.

“While better screening for these risk factors and earlier implementation of lifestyle modifications are essential, future research is needed to examine the longitudinal efficacy and safety of interventions including [hydroxychloroquine] use in alleviating metabolic syndrome and the progression of atherosclerosis in patients with SLE,” the researchers concluded.

Reference

Lertratanakul A, Sun J, Wu PW, et al. Risk factors for changes in carotid intima media thickness and plaque over 5 years in women with systemic lupus erythematosus. Lupus Sci Med. Published online December 8, 2021. doi:10.1136/lupus-2021-000548