Ann Rheum Dis 62:607-610 doi:10.1136/ard.62.7.607
  • Extended report

Increased carotid artery intima-media thickness may be associated with stroke in primary antiphospholipid syndrome

  1. G Medina1,
  2. D Casaos2,
  3. L J Jara3,
  4. O Vera-Lastra4,
  5. M Fuentes2,
  6. L Barile5,
  7. M Salas6
  1. 1Internal Medicine Department, Hospital General No 76, Mexico
  2. 2Imagenology Department, Hospital de Especialidades, Centro Médico La Raza, Mexico
  3. 3Clinical Research Unit, Hospital de Especialidades, Centro Médico La Raza, Mexico
  4. 4Internal Medicine Department, Hospital de Especialidades, Centro Médico La Raza, Mexico
  5. 5Rheumatology Department, Hospital de Especialidades, Centro Médico La Raza, Mexico
  6. 6Caro Research Institute, Concord MA, USA
  1. Correspondence to:
    Dr L J Jara, Clinical Research Unit, Hospital de Especialidades Centro Médico La Raza, Seris y Zaachila s/n, Colonia La Raza, IMSS, México City, CP 02990, Mexico;
  • Accepted 3 October 2002


Objective: To investigate the prevalence and clinical significance of carotid artery intima-media thickness (IMT) in patients with primary antiphospholipid syndrome (APS).

Methods: 28 patients with primary APS with at least a five year follow up, and 28 healthy subjects, matched by age and sex, were included in the study. Colour Doppler with high resolution B mode carotid ultrasonography and spectral analysis were performed in patients and controls. Information on cardiovascular risk factors and the clinical course were collected.

Results: The mean (SD) age of patients and controls (12 male, 16 female in each group) was 40 (8.5) years; the mean (SD) disease duration 7.7 (3) years. Carotid artery IMT was found in 23/28 patients (2.6 (1.14) mm) and 7/28 controls (1.2 (0.44)) (p=0.0001). A decrease in the lumen diameter was also found in 11/28 patients with primary APS without carotid atherosclerotic plaque, and 2/28 controls (p=0.004). Hyperlipidaemia, diabetes, smoking, obesity, and hypertension were not associated with carotid artery IMT. Patients with carotid artery IMT had arterial vascular disease more often than patients without: 9/23 v 0/5 (p<0.009). These patients had stroke (seven patients), myocardial infarction (one), and mesenteric thrombosis (one). Subjects with IMT had a threefold higher risk for stroke than those without IMT (95% CI 0.78 to 14.3).

Conclusions: Patients with primary APS have a high prevalence of carotid artery IMT and a decreased lumen diameter. IMT in primary APS may be associated with stroke. Patients with primary APS with IMT must be considered as carriers of atherosclerosis.