Background/Purpose: Cardiovascular disease (CVD) is a leading cause of death in systemic lupus erythematosus (SLE). The coronary artery calcium (CAC) score is a surrogate for atherosclerosis that strongly predicts incident coronary artery disease and major CVD events, independent of traditional Framingham risk factors. The prevalence of CAC deposition in SLE patients over the age of 45 is higher compared to the Multi-Ethnic Study of Atherosclerosis (MESA) cohort; however, data on patients <45 years of age is limited. We evaluated CAC scores in younger SLE patients, compared to healthy controls from the Coronary Artery Risk Development in Young Adults (CARDIA) cohort.

Methods: We identified 45 SLE patients who met 1997 ACR classification criteria, with no known coronary artery disease, and who had a non-contrast chest CT performed as part of their routine clinical care with images retrievable for calculation of CAC using the Agatston score. Demographics, disease characteristics, and comorbidities were ascertained. Prevalence of any calcification – defined as CAC>0 – was reported and compared with data from the CARDIA cohort, a large biracial U.S. cohort of patients ages 33 to 45 at time of chest CT scan for CAC determination. Additionally, within our SLE cohort, we investigated the relationship between disease characteristics and presence of coronary artery calcification.

Results: The 45 SLE patients were 39±14 years old, 89% female, 38% Hispanic, and 38% African American, with a disease duration 9±7 years. Patients met on average 5±1 ACR-SLE classification criteria; all had positive ANA titers; and 58% had elevated dsDNA titers. The average SLE disease severity index¹ was moderate (5±3), 42% had lupus nephritis, and 36% tested positive for antiphospholipid (APL) antibodies. CAC>0 was noted in 47% of all patients, with 41% of patients age <45 and 56% of patients age ≥45 having positive CAC. Out of the patients with positive CAC, 81% of patients had CAC scores between 1 and 100 and 19% had CAC scores >100. When compared with the CARDIA subjects, more SLE patients aged<45 had a CAC>0 (41.4% vs 9.6%, p-value <0.00001). Additionally, 45% of SLE patients ages 18 to 32 and 5 years median SLE disease duration, had abnormal CAC scores; the youngest of whom was 21 years old. There were no significant differences in SLE disease duration, SLE severity index, lupus nephritis, APL positivity, BMI, smoking status, presence of hypertension or diabetes between patients with and without CAC.

Conclusion: Young SLE patients have significantly higher CAC scores compared with the general population. A positive CAC score was seen in 41% of SLE patients <45 year-old and 45% of SLE patients <32 years old. Our data suggest that subclinical atherosclerosis in SLE develops as early as the second decade of life, and warrants screening and cardio-protective interventions.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/young-sle-patients-have-higher-coronary-artery-calcium-scores-compared-with-population-controls/