Background/Purpose: To date, the prevalence and prognosis of coronary artery disease (CAD) according to the coronary calcium score (CCS) and coronary artery calcification (CAC) using coronary computed tomography in patients with rheumatic diseases, including systemic lupus erythematosus (SLE), have been investigated in various studies, but with conflicting results. The latest American Heart Association and American College of Cardiology (AHA/ACC) guidelines for the primary prevention of atherosclerotic cardiovascular disease (CVD) permit the CAC score to be used in intermediate-risk patients, in whom additional individual risk-enhancing clinical factors such as chronic inflammatory disease, such as SLE are present, if the risk level is uncertain.

The aim of this systematic review and meta-analysis was to synthesize the evidence on this topic.

Methods: Relevant literature was identified and evaluated from inception until January 2021 through multiple search strategies on PubMed, Embase, Web of Science and Cochrane library. Cross-sectional or cohort (baseline data) studies reporting CAC prevalence and the extent of CAC identified by the CCS were included. Data extracted from eligible studies were used to calculate estimated effect sizes (ESs) and 95% confidence intervals (95%CI) and weighted mean differences (WMD) with 95% CI (PROSPERO registration number: CRD42021228710).

Results: The search retrieved 80 articles, of which 23 were eligible for inclusion. For the CAC prevalence, 10 studies were included (842 SLE patients and 910 controls) and the pooled prevalence of the random effect size was 28.7% (95%CI 25.7-31.9%) for SLE patients and 19.3% (95%CI 16.2-21.4%) in controls (RR 1.92, 95%CI 1.3 to 2.9; p< 0.0001) with substantial heterogeneity (I²= 74%, p < 0.0001) (Fig 1) and there was no significant increase in the WMD for CCS (MD= 0.32, 95%CI -5.55 to 6.20, p= 0.91 and I2= 50%, p= 0.06) compared with controls (Fig 2), using data from 7 studies. Limited evidence suggests that patients with SLE had more multivessel CAD. Greater organ damage was associated with a higher CCS. Glucocorticoid use was associated with both prevalence or progression in CAC. According to two studies, coronary computed tomographic angiography showed the calcified and non-calcified plaque burden were increased in SLE patients compared with controls.

Conclusion: In patients with SLE, asymptomatic CAD by CAC is more prevalent and shows more multivessel disease compared with controls without lupus. However, the extent of CAC was not increased in SLE patients.

ACR Meeting Abstracts - https://acrabstracts.org/abstract/asymptomatic-coronary-artery-disease-assessed-by-coronary-computed-tomography-in-patients-with-systemic-lupus-erythematosus-a-systematic-review-and-meta-analysis/