Background/Purpose:

SLE is an independent risk factor for cardiovascular disease (CVD). Traditional risk assessment tools underestimate the actual CVD risk of these patients limiting the possibility of establishing primary prevention strategies. Vascular ultrasound (US) is an accurate, non-invasive, non-irradiating method to assess asymptomatic patients thus providing valuable insight into their real CVD risk. To our knowledge, to date only carotid US studies have been performed to assess atherosclerotic burden in patients with SLE. We propose that 4-point vascular assessment including both the carotid and femoral territories increases the sensitivity of the method and would be beneficial in assessing CVD risk in patients with SLE.

Methods: We performed US of carotid and femoral territories in 100 patients who fulfilled ACR classification criteria for SLE and had no prior diagnosis or symptoms of CVD. Intima-media thickness (IMT) of the common carotid artery (CCA) and carotid bulb were measured. Plaque and thickened IMT (>0.1cm) were defined according to the Mannheim Carotid IMT Consensus. Data on auto-antibody profile, lipids, treatment and smoking status were obtained through clinical records and patient interviews. The 10-year risk for myocardial infarction (MI) using the Framingham risk score was calculated

Results: Of the 100 asymptomatic patients, 95% were women and the overall mean age was 45.2 years (SD 12.4; range 20-66). 56 patients were Caucasian, 25 were of Afro-Caribbean-origin, 11 were Asian and 8 patients had other ethnic backgrounds (Chinese or mixed race).Only 2 had thickened IMT in the CCA but 37 had plaque. This included 14 with only carotid plaque, 7 with only femoral plaque and 16 with both. 15 had plaque in at least 3 sites. Patients with plaque were significantly older than patients without plaque at diagnosis (mean age 33 vs 27 yrs, P=0.006) and at time of scan (54 vs 40 yrs, P<0.0001) and had longer disease duration (21 vs 14 yrs, P=0.002). There were no differences in auto-antibody profile, lipids, smoking status and treatment between patients with or without plaque. The mean Framingham 10 year risk for MI for all 100 patients was <1% and there were no differences between patients with or without plaque. Interestingly, patients who had plaque on the femorals had significantly thicker carotid IMT compared to those who didn’t even in the absence of carotid plaque (p=0.015).

Conclusion: Our results confirm a high prevalence of asymptomatic atherosclerotic plaque in patients with SLE even where Framingham risk scores are low and show that femoral as well as carotid ultrasound may well be valuable. In particular, almost a fifth of patients with plaque had femoral lesions only.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/ultrasound-assessment-of-both-carotid-and-femoral-arteries-in-patients-with-systemic-lupus-erythematosus-increases-sensitivity-for-detecting-asymptomatic-atherosclerosis/