Study: CVD Progression in SLE Patients

In a recent study, researchers evaluated the risk of cardiovascular disease (CVD) in systemic lupus erythematosus (SLE) patients, and the complications CVD creates in disease management. 

Two hundred female SLE patients were assessed, of whom 124 were available for follow-up. Patients were assessed for CVD risk at baseline by measurement of carotid intima-media thickness (CIMT) and plaque via B-mode Doppler ultrasound. After 3.5 years, a repeat carotid Doppler evaluated plaque and CIMT progression. 

The follow-up assessment showed new plaque development in 32 (26%) patients and plaque progression in 52 (41%) patients. Older age (odds ratio [OR] 1.13; 95% CI 1.06 to 1.20), anticardiolipin (OR 3.36; 1.27 to 10.40), and anti-Ro (OR 0.31; 0.11 to 0.86) antibodies were all risk factors for plaque progression. Over 5.8 years, more patients experienced CVD events (7.2%) than researchers predicted (1.0%) using the Framingham risk score (p < 0.001). Independent risk factors for future CVD events were higher triglycerides (OR 3.6; 1.23 to 10.56), exposure to cyclophosphamide exposure at anytime (OR 16.7; 1.46 to 63.5), and baseline Systemic Lupus International Collaborating Clinics damage index score (OR 9.62; 1.46 to 123) independently predicted future CVD events. 

With the exception of triglyceride levels, traditional CVD risk factors were not enough to predict adverse CVD events, the researchers observed. 

“It is interesting to note that neither CIMT nor the presence of plaque at baseline were associated with CVD events at follow-up and that different baseline factors predicted subclinical and clinical outcomes,” they said. “Both CIMT and carotid plaque have been shown to be predictors of long-term cardiovascular mortality in large population studies.” 

The study was limited by its small sample size and short duration, the researchers wrote. 

“Our results suggest that a more comprehensive approach to risk stratification is needed as well as classic risk factors, for example, triglycerides which are less often a target for intervention also contribute to future CVD events in SLE,” the study authors concluded. “A higher-risk population may also be identified from patients who require potent immunosuppression as well as those with anticardiolipin antibodies. Such factors may be a useful adjunct to routine CVD screening approaches and may result in improved CVD risk in this high-risk population.” 

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Source: Lupus Science & Medicine