Background Atherosclerosis is accelerated in systemic lupus erythematosus (SLE). Cardiovascular disease has become a major cause of morbidity and mortality in SLE. Carotid intima media thickness (IMT) is considered as a noninvasive surrogate marker of early atherosclerosis. Studies in SLE showed an accelerated progression of IMT and plaques in carotid arteries [1,2]. However, very few studies in SLE included ultrasound (US) examination of femoral arteries.
Objectives To assess the influence of SLE and its clinical and laboratory features on carotid and femoral IMT and the prevalence of plaques.
Methods 90 SLE patients and 82 age- and sex-matched controls were included in the study. IMT of the common carotid artery (cIMT) and superficial femoral artery (fIMT) was determined by B-mode US imaging. Carotid and femoral arteries were also screened for the presence of atherosclerotic plaques. Clinical work-up included laboratory tests and determination of disease activity and disease-related damage (SLICC).
Results cIMT and fIMT were similar in SLE patients and controls, while the plaque prevalence was greater in SLE (12/90 vs. 2/82 (p=0.009). cIMT was correlated with SLE duration (0.513mm, 0.567mm and 0.656mm in patients with SLE duration <1yr, 1-10yrs and >10yrs, respectively, p=0.025). A significant correlation was also found between the presence of plaques and SLICC index (p=0.01). Most plaques (9/12) were found in patients older than 40yrs and with SLE duration >1yr; interestingly in 6 patients from this subgroup plaques were only found in femoral arteries and the prevalence of carotid plus femoral plaques (34.6%) was significantly greater than the prevalence of carotid plaques (11.5%, p=0.048).
Conclusions We observed a higher prevalence of atherosclerotic plaques in SLE than in controls. Plaques prevalence was related to SLICC index. We didn’t find significant differences in cIMT and fIMT in SLE and controls. However, cIMT was correlated with SLE duration. A study of Li et al. in type 2 diabetes showed that a combination of carotid and lower extremities ultrasonography increases the detection of atherosclerosis . Our study suggests a similar effect in SLE.
Tyrrell PN et al. Rheumatic Disease and Carotid Intima-Media Thickness. A Systematic Review and Meta-Analysis. Arterioscler Thromb Vasc Biol 2010; 30(5): 1014-26.
Thompson T et al. Progression of |Carotid Intima-Media Thickness and Plaque in Women with Systemic Lupus Erythematosus. Arthritis Rheum 2008; 58(3): 835-42.
Li L et al. The combination of carotid and lower extremity ultrasonography increases the detection of atherosclerosis in type 2 diabetes patients. J Diabetes Complications 2012 [Epub ahead of print].
Disclosure of Interest None Declared