Background Systemic lupus erythematosus (SLE) is associated with a higher cardiovascular risk (CVR), at least doubled when compared with the general population, as well as an increased prevalence of atherosclerosis,which occurs prematurely and independently of traditional CVR factors. The presence of atheromatous plaques documented with carotid ultrasound (US) examination implies a change in the patient's CVR category to “very high risk”,according to the “European Guidelines on cardiovascular disease prevention in clinical practice, 2016”. General guidelines do not take into account the specific increase in CVR risk that it's present in patients with autoimmune diseases.
Objectives To examine if the use of carotid US leads to a more accurate CVR classification in SLE patients, and in that way to a better CVR management.
Methods Cross-sectional study that emcompassed 102 SLE patients currently being followed in our Rheumatology Department. Demographic variables, the presence of CVR factors and previous/current CV events, disease duration and drug use were analysed; lipid profile was assessed using blood tests, as well as carotid intima media thickness and the presence of carotid plaques using US scan. The current CVR status was calculated using the SCORE classification (low risk <1%, moderate risk <5%, high risk <10% and very high risk >10%).
Results 95% of our patients were women,mean age was 51.6+/- years,median disease duration was 16 years (IQR 9–28). 35.29% of patients presented with at least one CVR factor before the SLE diagnosis,and 61.76% at the time of the research (19.60% current smokers, 39.21% high blood pressure (HBP),33.33% dyslipidemia, 7.84% type II diabetes. A CV event was diagnosed in 11.76% of our patients throughout their SLE disease. According to the SCORE classification,55 of them had a low CVR (53.92%),26 moderate CVR (25.49%),6 high CVR (5.88%) and 15 of them very highCVR (14.70%). Carotid plaques were found in 28 patients (27.45%): 23 of them had never had a CV event (22.54%),21.42% of them were current smokers,64.28% had HBP,53.57% dyslipidemia and 17.86% type II diabetes. After adjustment of the SCORE classification with the presence of carotid plaques,16.36% of patients from the “low CVR” category would be re-classified has having “very high CVR”, as well as 30.76% from the “moderate CVR” category and 50% from the “high CVR” category. Of note,8 patients within the “very high CVR” category also presented carotid plaques. Out of this patients with atheroma plaque,13 were not using statins,and in 2 of them it would have been mandatory in order to achieve the LDL <70mg/dl target. In 2 of the 15 patients that were indeed under statins this target was not achieved. 60.71% of the atheromatous patients were under hydroxicloroquine use and 17.64% of them used steroids as a regular basis (33.33% of them within the medium range dose)
Conclusions More than half of our SLE patients presented with at least 1 CVR factor. Around 15% of patients were categorised as “very high CVR” according to the SCORE classification.The presence of carotid plaque was found in 27.45% of our patients,and 82% of them hadn't suffered any CV event. The use of carotid US examination allowed us to re-classify 20 patients (19.60%)in the “very high risk” category according to the SCORE classification. The need for a change in CVR management (ie., change in statin regime)was demonstrated in 4 of this 20 “re-classified” patients.
Disclosure of Interest None declared