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Abstract Number: 2830

Non-Calcified Coronary Artery Plaque Associates with Adverse Lipoprotein Profiles in Systemic Lupus Erythematosus

Laura Durcan1, Armin Zadeh2, Margery Connelly3, James Otvos3, Laurence S Magder4 and Michelle Petri5, 1University of Washington, Seattle, WA, 2Johns Hopkins University School of Medicine, Baltimore, MD, 3LabCorp, Raleigh, NC, 4Epidemiology and Public Health, Division of Rheumatology, School of Medicine, Johns Hopkins University, Baltimore, MD, 5Rheumatology Division, Johns Hopkins University School of Medicine, Baltimore, MD

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: atherosclerosis and lipids, SLE

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Session Information

Date: Tuesday, November 15, 2016

Session Title: Systemic Lupus Erythematosus – Clinical Aspects and Treatment - Poster III: Biomarkers and Nephritis

Session Type: ACR Poster Session C

Session Time: 9:00AM-11:00AM

Background/Purpose: Systemic lupus erythematosus (SLE) associates with atherosclerotic cardiovascular (CV) disease and related mortality. This is contributed to, but cannot be fully explained, by traditional CV risk factors, treatments and SLE-specific factors. Coronary artery calcium scores (CAC), by computed tomography (CT) measure atherosclerotic burden and can predict CV events. Non-calcified plaque (NCP), common in SLE, can also be quantified and may be more metabolically active and unstable. Routine lipids are unhelpful in distinguishing SLE patients with or without either CAC or NCP. Nuclear magnetic resonance (NMR) spectroscopy allows determination of the size and concentration of lipoprotein classes and subclasses, and has been used to evaluate CV risk in many populations. The aim of this work is to determine whether differences in NMR lipoprotein particle numbers or size can distinguish between SLE patients with and without CAC. An additional aim was to establish whether NMR parameters associate with quantified NCP or calcified plaque.

Methods: As part of a longitudinal lupus cohort, SLE patients, without known atherosclerotic disease, had coronary CT angiography performed. CAC scores were calculated according to the Agatston system. Lipoprotein particle numbers and size were evaluated by NMR. The initial statistical analysis compared those with and without calcified and NCP using t-tests. Further evaluation involved the calculation of correlation coefficients to evaluate the relationship between lipoprotein abnormalities and the burden of calcified and NCP.

Results: Sixty-nine SLE patients were evaluated, 64 (93%) female, 49 (71%) were African-American and 20 (29%) were Caucasian. Significant NCP was present in 41 (59%) and CAC was present in 14 (20%). Individuals with NCP had significantly larger very low-density lipoprotein (VLDL) particles (44.8 ±5.5 nm versus 47.7 ±6.1 nm, p= 0.042). None of the other lipoprotein parameters were significantly different between those who had calcified or NCP. Considering the volume and extent of CAC and NCP; (Table 1) higher triglycerides were observed with increasing levels of CAC. Increasing volumes of NCP were associated with higher LDL particle number and larger VLDL size. The lipoprotein insulin resistance scores were also positively associated with NCP.

Conclusion: The mechanisms underlying atherosclerosis in SLE are poorly understood. NCP is highly prevalent in SLE and may be contributed to by differences in LDL, VLDL and insulin resistance measures, not evaluated in routine lipid profiles. Further longitudinal analysis will determine whether these abnormalities associate with progression of disease and can be considered prognostic markers.

Biomarker   Calcified Plaque Non-Calcified Plaque
Spearmen Correlation Coefficient P-value Spearmen Correlation Coefficient P-value
VLDL & Chylomicron Particles (total) (nmol/L) 0.05 0.67 -0.06 0.62
Large VLDL & Chylomicrons Particles (nmol/L) 0.20 0.09 0.18 0.13
Medium VLDL Particles (nmol/L) 0.07 0.56 -0.00 0.97
Small VLDL Particles (nmol/L) 0.00 0.99 -0.05 0.68
LDL Particles (total) (nmol/L) 0.14 0.26 0.26 0.034
IDL Particles (nmol/L) 0.05 0.66 -0.02 0.89
Large LDL Particles (nmol/L) 0.09 0.44 0.15 0.22
Small LDL Particles (nmol/L) 0.02 0.89 0.14 0.22
HDL Particles (total) (µmol/L) 0.17 0.17 0.16 0.20
Large HDL Particles (µmol/L) -0.04 0.75 -0.03 0.83
Large HDL Particles (µmol/L) 0.10 0.42 -0.07 0.57
Small HDL Particles (µmol/L) 0.11 0.36 0.21 0.086
VLDL Size (nm) 0.21 0.082 0.25 0.038
LDL Size (nm) 0.09 0.49 -0.05 0.70
HDL Size (nm) -0.08 0.50 -0.13 0.30
Triglyceride (total) (mg/dL) 0.24 0.043 0.20 0.10
Lipoprotein Insulin Resistance Score 0.21 0.080 0.24 0.044

Disclosure: L. Durcan, None; A. Zadeh, None; M. Connelly, LabCorp, 3; J. Otvos, LabCorp, 3; L. S. Magder, None; M. Petri, None.

To cite this abstract in AMA style:

Durcan L, Zadeh A, Connelly M, Otvos J, Magder LS, Petri M. Non-Calcified Coronary Artery Plaque Associates with Adverse Lipoprotein Profiles in Systemic Lupus Erythematosus [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/non-calcified-coronary-artery-plaque-associates-with-adverse-lipoprotein-profiles-in-systemic-lupus-erythematosus/. Accessed January 15, 2021.
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