Background/Purpose: Systemic lupus erythematosus (SLE) is associated with an increased in the prevalence of atherosclerosis. Composite scores of cardiovascular risk factors in patients with SLE have been found to underestimate cardiovascular risk. Besides, ultrasound of the carotid arteries has been proposed as a reclassification risk tool in inflammatory diseases. The main purpose of our study was to analyze the impact of ultrasound carotid assessment in the cardiovascular risk stratification of patients with SLE.

Methods: This cross-sectional study encompassed 276 SLE patients. Lipid profile, SCORE risk calculation, and disease activity (SLEDAI), severity (Katz), and damage (SLICC) indexes were assessed. Carotid intima-media thickness (cIMT) and carotid plaques were determined through ultrasound evaluation. Reclassification of SCORE after ultrasound carotid assessment was performed. A multivariable regression analysis, adjusted for classic cardiovascular related factors, was performed to evaluate how risk reclassification is influenced by disease characteristics in SLE patients and to describe potential predictors of this risk reclassification.

Results: Patients had a mean ± SD age of 51 ±12 years. The median SLE disease duration was 18 ± 10 years and SLICC and Katz indexes were, respectively, 1 (interquartile range –IQR- 0-2) and 2 (IQR 1-4). Thirty-four percent of the patients were categorized as having no activity based on the SLEDAI index, while 31%, 17%, and 8% were classified, respectively, in the mild, moderate, and high or very high categories. According to the SCORE risk stratification system, 184 (67%) and 73 (27%) patients were respectively in low and moderate categories. Additionally, only 16 (6%) patients were considered in high or very high risk categories. However, after carotid ultrasound assessment, 37% (100) of the patients were considered to be in the very high risk category. Exactly, 64 patients, 43 in both the low and moderate category, moved into very high category. Patients that experienced reclassification compared to those that did not were older (48 ± 11 vs. 57 ± 9 years, p=0.000) and had more hypertension (31 vs 56 %, p=0.000). Gender, BMI, waist circumference and the presence of dyslipidemia, smoking or diabetes did not shown differences. Lipid profile disclosed no differences between reclassified or non reclassified subjects. Disease duration was related to reclassification after multivariable analysis (OR 1.04 [95%CI 1.00-1.07], p=0.025). Similarly, a SLICC higher or equal to 1 (OR 2.48 (95%CI 1-15-5.34), p=0.020) and log SLICC (OR 1.63 (1.01-2.64), p=0.045) disclosed statically significant relation to reclassification after multivariable adjustment. These relations were also found when SLICC was used without the cardiovascular item that its contains although in the case of log SLICC the significant was not completely found (OR 1.56 (95%CI 0.95-2.64), p=0.077).

Conclusion: Reclassification into very high SCORE category is frequent after carotid ultrasound assessment in SLE patients. This reclassification can be independently explain by the damage produced by the disease and makes candidates for more intensive preventive interventions to one out of every three patients evaluated.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiovascular-risk-re-classification-using-carotid-ultrasound-in-systemic-lupus-erythematosus-patients-is-related-to-the-damage-produced-by-the-disease/