Background/Purpose: Systemic lupus erythematosus (SLE) seems associated with an increased risk of cardiovascular disease. These data are mainly based on studies mostly from North America. The aim of this study was to investigate the prevalence of subclinical atherosclerosis in a large cohort of SLE patients in France.

Methods: In this retrospective cohort study, 282 SLE patients underwent screening for subclinical atherosclerosis from January 2014 to April 2016. The presence of subclinical atherosclerosis was evaluated using a carotid ultrasound examination with measurement of intima media thickness (IMT) and electron-beam computed tomography to screen for coronary artery calcification (CAC). CAC was divided in 4 categories: 0; 1- 99; 100 – 399 and ≥ 400. SLE characteristics and cardiovascular risk factors were included in a regression analysis to determine the importance of SLE specific features in the occurrence of subclinical atherosclerosis in the female subpopulation.

Results: From the eligible cohort of 282 patients, 19 patients (6.7%) were excluded because of the presence of prior cardiovascular events. 263 (240 women, 91.3%) patients free from cardiovascular disease were included. The mean age of the study population was 42.6 +/- 13.2 years. 35.4% suffered from arterial hypertension, 20.6% were current smokers, 5.3% had diabetes, 26.2% had a dyslipidemia and 2.3% had a familial history of cardiovascular disease. The mean BMI was 24.8 kg/m² +/- 5.4. 58.8 % of the study population had disease duration of at least 10 years and 25.5% had a SLICC score > 0. 89% of the patients were treated with hydroxychloroquine, 53.6% with corticosteroids and 28.5% with at least one other immunosuppressive agents. The prevalence of carotid plaques was 20.3% (19.2% in women and 32% in men, p = 0.17). The median value of the IMT was 0.53 mm (IQR [0.47; 0.60]). 25% of the patients had a CAC > 0: 17.3% between 1 – 99; 5.2% between 100 – 399 and 2.4% ≥ 400. Using multivariable logistic regression analysis the presence of carotid plaques in women was significantly associated with age with an adjusted Odds ratio (OR) for each supplementary year of 1.12 (95%CI, 1.07;1.16), controlling on smoking habit. CAC score > 0 in women was significantly associated with age (OR per year = 1.14, 95% CI [1.09; 1.19]) and current treatment with immunosuppressive drugs (OR = 2.70; 95%CI [1.08; 6.71]), controlling on smoking habit. IMT was significantly associated with age, with the presence of diabetes and lupus nephritis. Patients with diabetes had a mean IMT that was 116 µm (95% CI, 49;184) higher than those without diabetes. Treatment with glucocorticosteroids and the presence of an antiphospholipid antibody syndrome was not associated with an increased risk for subclinical atherosclerosis.

Conclusion: In this retrospective cohort, the CAC and IMT did not seem to be elevated compared to published series of SLE patients. Besides an expected association with classical atherosclerotic risk factors including age, diabetes, and smoking, disease-related factors such as treatment with immunosuppressive agents and lupus nephritis are associated with subclinical atherosclerosis.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/is-subclinical-atherosclerosis-prevalent-in-a-french-patient-cohort-with-systemic-lupus-erythematosus/