Background/Purpose: Systemic lupus erythematosus (SLE) patients have increased risk of advanced atherosclerosis and cardiovascular disease. The mechanism of premature atherosclerosis in SLE is not completely understood, and systemic inflammation representing disease activity and traditional risk factors such as overweight and dyslipidemia have been regarded to contribute. Many SLE patients have low disease activity or sporadic occurrence of mild symptoms after a period of vigorous manifestations derived from autoimmune activation. It has not been evaluated whether SLE patients with mild activity have a risk of atherosclerosis progression, while it’s a common situation which many SLE patients are undergoing. Previously we evaluated subclinical atherosclerosis of SLE patients with mild disease activity by Doppler ultrasound 4 years ago. This time we checked them again and assessed which features affects their changes.

Methods: We assessed carotid artery intima-media thickness (cIMT) and carotid plaque by Doppler ultrasonography among sixty-one female SLE patients who were enrolled in the previous work 4 years ago, and analyzed the changes with clinical characteristics.  

Results: The SLE disease activity index of the participants was 4.2 ± 3.9, and 25(OH)D₃ level was elevated than previous study (25.7 ± 6.9 vs 12.7 ± 8.6 ng/mL, p < 0.001), while other features were similar. The mean cIMT of SLE patients was 0.39 ± 0.09 mm and 11 patients had carotid plaques, which were not significantly different with previous study. Twenty one patients had the increased cIMT, while 35 patients had decreased cIMT. And new carotid plaque was developed in 7 SLE patients, while the carotid plaque of 10 SLE patients was resolved. The patients with increased cIMT had lower body mass index (BMI) (19.8 ± 1.8 vs 21.7 ± 3.1 kg/m², p = 0.007), longer disease duration (102.0 ± 42.2 vs 74.8 ± 55.2 months, p = 0.006) and higher total steroid dose (18.5 ± 21.6 vs 10.5 ± 22.9 g, p < 0.001) compared with those not. The patients having new carotid plaque had lower high-density lipoprotein (HDL) cholesterol levels (41.6 ± 10.2 vs 55.6 ± 15.5 mg/dL, p = 0.024) and were taking higher doses of current steroid (8.9 ± 9.5 vs 3.6 ± 4.5mg, p = 0.008). On multiple regression analysis, BMI (0.62 [0.42 – 0.91], p = 0.01) and HDL cholesterol (0.94 [0.89 – 1.0], p = 0.02) were revealed to affect cIMT increment, and current steroid dose (1.14 [1.01 – 1.28], p = 0.04) were revealed to affect plaque development.  

Conclusion: BMI have been known to affect atherosclerosis and vitamin D deficiency has been known to associate with cardiovascular disease. In contrast of other studies, our data showed BMI contributed negatively cIMT increment. The result about BMI was regarded that very low BMI might have a harmful effect to atherosclerosis, considered that mean BMI was much lower (21.0 ± 2.8 kg/m²) than other studies.⁴ The follow up study for SLE patients with low disease activity showed low BMI and HDL cholesterol might be a risk factor for subclinical atherosclerosis and current steroid dose could be associated with plaque development.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/four-years-follow-up-of-subclinical-atherosclerosis-in-systemic-lupus-erythematosus-patients/