Background/Purpose:

Premature atherosclerosis is a major cause of morbidity and mortality in females with systemic lupus erythematosus (SLE), but little is known about the frequency, extent, and risk-factors of coronary-artery calcifications (CAC) in young patients with SLE.

Methods:

We studied 223 SLE patients (95 males and 128 females) attending our outpatient clinic and 193 healthy subjects (100 males, 93 females) w/o preexisting coronary heart disease, matched by age and race. Patients and controls had a standardized assessment of demographic characteristics and traditional cardiovascular risk factors. In addition, lupus patients had an evaluation of lupus characteristics, medications, and laboratory tests including immunological, extended lipid profile, homocystein, and hsCRP. All patients and healthy controls were screened for coronary-artery calcifications using a 64-slice Multidetector Computed Tomography and the extent of calcification was measured by means of the Agatson score.

Results:

Mean (SD) age of lupus patients and controls was 32.9 (9.4) and 33.5 (9.8) years, respectively. Coronary-calcifications were detected in 25 patients (11%) and 7 (4%) controls (OR 3.35, 95% CI 1.36-9.38, p=0.004). Median calcium score in patients was 15.9 (0.2-576.8), and 7.7 (1.1-140.2) in controls. Calcifications in lupus patients and controls were detected since age 32 and 41 years, respectively. In two patients, calcifications were detected within 3 years of diagnosis. The multivariate analysis showed that age (OR 1.13, 95% CI 1.08 – 1.18), smoking (OR 3.50 95% CI 1.32 – 9.27), male gender (OR 2.62 95% CI 1.04 – 6.57), and SLE diagnosis (OR 4.41 95% CI 1.64 – 11.85) were associated with CAC in the whole population.

Among the lupus patients, those with calcifications were older (42.1 + 8.6 vs 31.8 + 8.9 years, P<0.001), males (68% vs 39%, P=0.006), waist (91.4 + 14.2 vs 85.6 + 12.7 cm, P=0.02), current smoking (32% vs 10%, P=0.006), hypertension (48% vs 28%, P=0.04), homocysteine levels (17.1 + 14.8 vs 11.7 + 6.4, P=0.009), Framingham risk score [5(1-25) vs 1(1-13), P<0.001], MetS (44% vs 15% , P=0.001].  Lupus duration was longer (11.1 + 8.9 vs 5.8 + 4.3 years, P=0.006), and cumulative dose of prednisone higher [61.7(0.24-454.2) vs 49.9(8.5-106.5) grams, P=0.001] in comparison to patients with no calcifications. No difference was observed in lupus manifestations, clinical activity during the course of the disease, autoantibodies, and use of anti-malarials and aspirin. Logistic regression adjusting by disease duration showed an independent association of age (OR 1.12, 95% CI 1.05-1.16, p= P<0.001), smoking (OR 3.69, 95% CI 1.04-13.1, p=0.04) and cumulative dose of prednisone (OR 1.03, 95% CI 1.005-1.06, p=0.02) with calcifications.

Conclusion:

Asymptomatic coronary-artery calcifications are more common, extensive, and present at younger age in SLE patients than in the controls. Their association, principally to traditional risk-factors than lupus characteristics, raise the possibility of modifying their burden.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-and-risk-factors-for-asymptomatic-coronary-artery-calcifications-in-young-patients-with-systemic-lupus-erythematosus/