Background/Purpose

Systemic lupus erythematosus (SLE) patients are at risk of premature cardiovascular disease (CVD). The specific reason of this situation is still debatable. Subclinical atherosclerosis prevalence and characteristics in Mexican mestizo patients with SLE is unknown. The objective of this study is to evaluate the presence of carotid plaque (CP) and carotid intima-media thickness (CIMT) in Mexican mestizos with SLE and to compare them to a control group.

Methods

An observational, cross-sectional study in a Mexican mestizo population was realized. 69 SLE patients, age ranging from 18 to 53 years, and 69 age-sex-diabetes-hypertension matched controls were included. Their demographic profile, biochemical, anthropometric measurements, traditional risk factors for atherosclerosis and disease-related factors were recorded. Carotid evaluation was realized by B mode carotid Doppler ultrasonography. CP was defined as presence of focal thickening at least 50% greater than that of the surrounding wall or CIMT ≥ 1.2 cm. The CIMT was measured at 1 cm proximal to the start of the carotid bulb dilatation of the common carotid artery in the far wall. The maximum CIMT value was recorded.

Results

Demographic differences between groups included a higher prevalence of CVD familiar history in the SLE group (p≤0.001), higher diastolic and systolic blood pressure in the SLE group (p≤0.001), and higher weight in the control group (p=0.013). Only 2 subjects of each group had diagnosis of hypertension, and 1 subject of each group had diagnosis of diabetes at the time of the enrollment to the study.

The mean CIM value in SLE patients was 0.514 ± 0.098 mm while the control group had a mean of 0.518 ± 0.108 mm (p=0.830). CP was found in 11 patients with SLE and 4 in the control group (p=0.360). SLE patients with CP had lower levels of total cholesterol (p=0.021), low density lipoprotein cholesterol (p=0.030) and glucose (0.003) compared with the control group with CP.

Patients in the SLE group with steroid use for more than five years were more likely to have CP or increased CIMT (p=0.023). Use of synthetic DMARD was associated with lower probability of CP or increased CIMT (p=0.048). This association was not found with biological DMARD (p=0.422).

Conclusion

Our study has shown that despite high prevalence of traditional cardiovascular risk factors among Mexicans SLE patients, the CP/CIMT findings were not completely attributable to them. These findings agree with most previously published reports in other populations including Asians, Caucasians and African-Americans. The actual evidence suggests that SLE itself is an independent predictor of atherosclerosis. The systematic carotid evaluation could be an important surrogate biomarker of premature atherosclerosis in our patients, and we recommend their systematic use.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/carotid-intima-media-thickness-and-plaque-in-mexican-mestizos-with-systemic-lupus-erythematosus-a-case-control-study/