Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Atherosclerosis in SLE; a Cross Sectional Study of 223 Patients with 223 Individually Matched Population Controls.

Gustafsson2,  Johanna T., Jensen1,  Kerstin Urstad, Herlitz-Lindberg1,  Marie, Moller4,  Sonia, Petterson3,  Susanne, Gunnarsson2,  Iva, Svenungsson2,  Elisabet

Department of Clinical Physiology, Södersjukhuset, Karolinska Institute, Stockholm, Sweden
Department of Medicine Solna, Karolinska Institute. Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
Department of Neurobiology, Care Sciences and Society (NVS), Division of Nursing, Karolinska Institutet, Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden
Rheumatology Unit, Karolinska University Hospital, Stockholm, Sweden

Objective:

Accelerated atherosclerosis is believed to contribute to premature cardiovascular disease (CVD) in patients with Systemic Lupus Erythematosus (SLE). We investigated the prevalence of subclinical atherosclerosis in SLE patients and controls.

Patients and Methods:

223 SLE patients/ 223 population controls, individually matched for age, sex and region of living were included after overnight fasting. All were investigated clinically including CVD risk factors and inflammatory biomarkers. The same investigator performed B-mode ultrasonography of carotid arteries. Intima media thickness (IMT) and plaques occurrence (local intima-medial thickening >1mm) were tabulated

Results:

Mean age was 48,5 ± 14,3 years in patients and 48,7 ±14,2 in controls. Manifest CVD (ischemic heart, cerebro- and peripheral vascular disease) was more common in SLE patients (13 % vs. 3 %, p <0.0001). Patients were more likely to smoke, have antihypertensive and lipid lowering treatment, lower high density lipoprotein, and higher triglycerides (TG). They had lower low density lipoprotein levels (p<0.05 for all).

Patients had thicker mean IMT than controls (p=0.02), but there was no difference in plaque occurrence, 21% and 17% respectively.

After age adjustment:

Manifest CVD was associated with plaques in the SLE group, but not with IMT.

In SLE, IMT was positively associated with systolic blood pressure (sBP, <0.0001), TGs (p=0.008) and hemoglobin levels(p=0.04) and negatively with discoid skin lesions (p=0.03) and leukopenia(p=0.03). Plaques were positively associated with TGs (p=0.01) and systolic blood pressure (p=0.02) and negatively with discoid skin lesions (p=0.04).

In controls, IMT was associated with high CRP levels (p=0.02) and sBP (<0.0001). Smoking (p=0.03) and TG levels (p=0.03) were associated with plaques.

Multivariable adjusted models:

In patients age and sBP remained associated with IMT (p<0.001 for both) and plaques (p<0.001 and p=0.01 respectively). In controls age (p<0.001) and sBP (p=0.001) remained associated with IMT and age (p<0.001) and smoking (p=0.03) with plaques.

Conclusions:

This is to our knowledge the largest study of subclinical atherosclerosis in SLE patients. Patients had thicker IMT, but we could not confirm the increased prevalence of carotid plaques previously reported. Selection of controls, definition of plaques and possibly ethnicity are possible underlying explanations. Plaques and IMT were mainly associated with traditional CVD risk factors in both patients and controls. The relative contribution of subclinical atherosclerosis for hard outcomes i.e. events in SLE needs to be investigated and should be in focus of future studies.

To cite this abstract, please use the following information:
Gustafsson, Johanna T., Jensen, Kerstin Urstad, Herlitz-Lindberg, Marie, Moller, Sonia, Petterson, Susanne, Gunnarsson, Iva, et al; Atherosclerosis in SLE; a Cross Sectional Study of 223 Patients with 223 Individually Matched Population Controls. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1846
DOI: 10.1002/art.29611

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