Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: Cardiovascular disease is a leading cause of morbidity and mortality in adults with systemic lupus erythematosus. Exposure to atherogenic risk factors in childhood-onset SLE (cSLE) likely leads to accelerated atherosclerosis. The aim of the study was to determine the effect of disease duration on vascular surrogates of early atherosclerosis in cSLE. We hypothesized that longer disease duration would negatively impact vascular measurements.
Methods: A cross-sectional analysis of a prospective longitudinal cSLE cohort was performed. All subjects fulfilled ≥ 4/11 American College of Rheumatology classification criteria for SLE. Disease activity (adjusted mean SLEDAI), disease damage (SLICC/ACR DI) and medications were recorded. Homocysteine, fasting lipid and inflammatory profiles were performed. Carotid intima-media thickness (CIMT), flow-mediated dilation (FMD) and pulse wave velocity (PWV) were measured using standardized protocols. Data from the last set of vascular studies were used. Vascular data of cSLE patients were compared to those of 138 healthy controls.
Results: One hundred and forty-nine cSLE patients participated in the study (Table). Mean disease duration at the most recent study visit was 3.5±2.6 years. Seventy-three percent of cSLE subjects had inactive disease with a SLEDAI score ≤2. CIMT and FMD were not worse in cSLE patients when compared to controls. PWV was slightly higher in cSLE patients. We observed a negative correlation between disease duration and FMD (r=-0.18, p=0.03) but not with CIMT or PWV. In multivariable linear regression analysis, longer disease duration was significantly associated with worse FMD (p=0.02). Gender, a history of lupus nephritis, inflammatory markers, the adjusted mean SLEDAI and the cumulative glucocorticoid dose did not significantly impact on vascular data.
Conclusion: In this large single-center cSLE cohort, longer disease duration was associated with worse FMD, suggesting progressive endothelial dysfunction over time. CIMT and PWV were independent of disease duration.
Table. Characteristics of cSLE patients and controls.
|
|
cSLE (n=149) |
Controls (n=138) |
p value |
|
Male:female ratio |
25:124 |
69:69 |
<0.001 |
|
Age at vascular test (yrs) |
16.3±2.4 |
14.4±2.3 |
<0.001 |
|
BMI, percentile |
66±27 |
55±29 |
0.001 |
|
SBP, percentile |
52±29 |
45±27 |
0.04 |
|
DBP, percentile |
42±25 |
30±21 |
<0.001 |
|
Disease duration (yrs) |
3.5±2.6 |
|
|
|
Lupus nephritis, n (%) |
54 (36) |
|
|
|
Neuropsychiatric lupus, n (%) |
43 (29) |
|
|
|
Adjusted mean SLEDAI |
3±2 |
|
|
|
SLICC/ACR DI |
0 |
|
|
|
Ever on glucocorticoid, n (%) |
139 (93) |
|
|
|
Cumulative prednisone dose (mg/kg) |
303±260 |
|
|
|
Cholesterol-total (mmol/L) |
4.03±1.00 |
|
|
|
LDL-cholesterol (mmol/L) |
2.13±0.78 |
|
|
|
HDL-cholesterol (mmol/L) |
1.39±0.41 |
|
|
|
Triglyceride (mmol/L) |
1.11±0.56 |
|
|
|
Vascular measurements*: |
|
|
|
|
CIMT (mm) |
0.410±0.056 |
0.437±0.047 |
<0.001 |
|
FMD (% change) |
9.1±4.2 |
7.5±3.1 |
0.003 |
|
PWV (m/s) |
5.3±0.9 |
5.1±0.9 |
0.04 |
Numbers are presented as mean±SD unless otherwise specified.
*CIMT (n=148), FMD (n=142), PWV (n=146)
Disclosure:
J. Barsalou,
GlaxoSmithKline,
9;
T. J. Bradley,
None;
C. Slorach,
None;
L. W. K. Ng,
None;
D. M. Levy,
None;
E. D. Silverman,
None.
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