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.


Non-Calcified Coronary Plaque (NCP) in Systemic Lupus Erythematosus (SLE): Quantitative Analysis.

Kiani2,  Adnan N., Vogel-Claussen2,  Jens, Yew2,  Margaret, Magder3,  Laurence S., Petri1,  Michelle A.

Timonium, MD
Johns Hopkins University, School of Medicine, Baltimore, MD
University of Maryland, School of Medicine

Purpose:

Coronary calcium (CC) is increased in SLE. New technology (CTA) can measure non-calcified plaque (NCP). Noncalcified plaque is less stable and more prone to rupture. We report on the largest study of quantified non-calcified coronary plaque in SLE.

Methods:

64 slice coronary multidetector computed tomography (MDCT) was performed in 106 patients with SLE. The MDCT scans were evaluated quantitatively by a radiologist, using dedicated software.

Results:

The 106 SLE pts were 88% female, 67% Caucasian, 29% African-American, 4% other; mean age 51±11yrs. Significant results are shown in Table 1. Obesity was the major traditional CVRF associated with NCP. NCP did increase with age. NCP was increased with low complement, particularly with low C3. Anticardiolipin (but not lupus anticoagulant) was associated with increased NCP. Prednisone and Plaquenil therapy had no effect, but methotrexate use had increased NCP (table 1). In the best multivariate model (table 2) age, obesity, and MTX remained significant.

Table 1.

 GroupMean NCP Scorep-valuep-value for trend, controlling for age
Age  0.011 
 <45 (n = 30)0.16  
 45–55 (n = 39)0.21  
 55+ (n = 36)0.33  
Body Mass Index (BMI)  0.200.015
 <25 (n = 34)0.18  
 25–29 (n = 36)0.21  
Anticardiolipin antibodies (aCL)  0.0270.048
 No (n = 37)0.17  
 Yes (n = 69)0.28  
Low C3  0.290.068
 No (n = 51)0.21  
 Yes (n = 55)0.26  
Low C4  0.580.090
 No (n = 63)0.23  
 Yes (n = 43)0.25  
Current Prednisone  0.240.92
 No (n = 69)0.25  
 Yes (n = 36)0.22  
Current Plaquenol  0.540.91
 No (n = 21)0.21  
 Yes (n = 84)0.25  
Current Imuran  0.160.29
 No (n = 98)0.25  
 Yes (n = 8)0.12  
Current Methotrexate (MTX)  0.0110.0029
 No (n = 101)0.22  
 Yes (n = 5)0.51  
Current Cellcept  0.240.58
 No (n = 96)0.24  
 Yes (n = 10)0.20  
Current Non-steroidal anti-inflammatory drugs (NSAIDS)  0.950.74
 No (n = 62)0.24  
 Yes (n = 43)0.24  

Table 2. Multivariable regression model to assess the joint association of predictors and the mean level of NCP

VariableEffect on mean NCP score (95% CI)p-value
Age (per 10 years)0.08 (0.05, 0.12)<.0001
BMI (per 5 unit change)0.03 (0.00, 0.07).049
History of Anticardiolipin0.089 (-0.01, 0.17).097
Hypertension0.03 (-0.07, 0.13).54
MTX ever0.27 (0.07, 0.47).0076

Conclusion:

NCP is a better marker of immediate atherosclerotic risk than is calcified plaque. In our univariate analysis, low complement was associated with NCP. This is the only association with a marker of active lupus. Of the traditional CVRF- obesity- rather than hypertension- is strongly associated with NCP. Our results suggest that both active SLE (serologically) and traditional CVRF (obesity) contribute to NCP in SLE. The association with MTX is of concern, but should be replicated in larger studies and in multiple centers.

To cite this abstract, please use the following information:
Kiani, Adnan N., Vogel-Claussen, Jens, Yew, Margaret, Magder, Laurence S., Petri, Michelle A.; Non-Calcified Coronary Plaque (NCP) in Systemic Lupus Erythematosus (SLE): Quantitative Analysis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2122
DOI: 10.1002/art.29886

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