Session Information
Date: Monday, November 9, 2015
Title: Systemic Lupus Erythematosus - Clinical Aspects and Treatment Poster Session II
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: Accelerated atherosclerosis leading to premature coronary artery disease remains the major cause of late death in SLE. Coronary artery calcium (CAC) is a late phase of atherosclerosis. Noncalcified coronary plaque (NCP) represents an early inflammatory plaque more likely to rupture.
Methods: To determine rates of CAC and NCP progression and identify risk factors for progression, CT angiography was performed at baseline and after several years of follow-up in 38 SLE patients; 36 scans allowed repeat assessment of NCP and 35 for CAC. Duration between assessments was 2-3 years (13%), 3-4 years (53%), 4-7 years (21%) and >7 years (13%). Of the patients, 37% were below 45 years; 76% female; 74% Caucasian and 18% African-American. CAC was quantified by the Agatston score and classified as none, low (1-99) or high (100+). NCP was quantified based on a score that we have previously described and classified as none, low (<0.5) or high (0.5+). SLE disease activity was quantified using the SELENA-SLEDAI and Physician Global Assessment (PGA) indices. To assess the association between quantitative clinical variables and changes in NCP adjusting for time we fit linear regression models.
Results: Tables 1 and 2 show the follow-up classifications for CAC and NCP, respectively, by baseline classification.
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Table 1: Number (%) with CAC at follow-up by baseline level |
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Follow-up |
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Baseline |
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None |
Low |
High |
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None |
23 (96%) |
1 ( 4%) |
0 ( 0%) |
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Low |
1 (20%) |
3 (60%) |
1 ( 20%) |
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High |
0 ( 0%) |
0 ( 0%) |
6 (100%) |
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Table 2: Number (%) with NCP at follow-up by baseline level |
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Follow-up |
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Baseline |
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Low |
Medium |
High |
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Low |
4 (33%) |
3 (25%) |
5 (42%) |
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Medium |
1 ( 6%) |
13 (72%) |
4 (22%) |
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HIgh |
0 ( 0%) |
4 (67%) |
2 (18%) |
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For CAC, the pre-post scores agreed qualitatively for 32/35 (91%), while for NCP, the pre-post scores agree qualitatively for 19/36 (53%). Twelve (33%) had an increase in NCP while 5 had a decrease. Change in NCP was positively associated with time between assessments (estimated mean change score of 0.09 per year, p=0.038). Table 3 shows the association between various exposures experienced between the assessments and mean change in NCP score.
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Table 3. Mean change in NCP score by various clinical variables, adjusted for time between assessments. |
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Clinical Variable |
Mean Change* |
P-value |
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SLEDAI at the time of follow-up assessment |
0.01 (per 1 unit change) |
0.82 |
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PGA at the time of follow-up assessment |
-0.16 (per 1 unit change) |
0.28 |
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Mean SLEDAI |
-0.02 (per 1 unit change) |
0.63 |
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Mean PGA |
-0.19 (per 1 unit change) |
0.20 |
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Mean Systolic Blood Pressure |
-0.08 (per 10 mmHg change) |
0.19 |
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Mean Total Serum Cholesterol |
-0.08 (per 25 mm/dl change |
0.26 |
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History of Smoking |
-0.12 |
0.49 |
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Current Smoking |
-0.33 |
0.17 |
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Mean Lupus Anticoagulant (dRVVT) |
0.01 (per second) |
0.61 |
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Proportion of time with Low C3 |
0.06 (per 0.5 difference) |
0.66 |
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Proportion of time with Low C4 |
-0.01 (per 0.5 difference) |
0.95 |
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Proportion of time with positive anti-dsDNA |
0.11 (per 0.5 difference |
0.33 |
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Mean Daily Prednisone Dose |
-0.19 (per 10 mg/d difference) |
0.38 |
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Proportion of time on Plaquenil |
-0.07 (per 0.5 difference) |
0.71 |
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*Means and proportions calculated over the interval between the two plaque assessments. |
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Conclusion: Calcified coronary plaque levels were relatively stable over a period of 2-7 years. Noncalcified coronary plaque levels were more variable and more likely to increase over time. Those with longer duration of follow-up tended to have increases in noncalcified plaque. Traditional cardiovascular risk factors and SLE-related measures did not predict increases in noncalcified coronary plaque. Noncalcified coronary plaque, the plaque most likely to rupture and lead to a cardiovascular event, is likely to increase over time regardless of traditional cardiovascular risk factors and SLE clinical and serologic activity.
To cite this abstract in AMA style:
Petri M, Zadeh A, Kiani A, Magder LS. Progression of Noncalcified and Calcified Coronary Plaque (by CT Angiography) in SLE [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/progression-of-noncalcified-and-calcified-coronary-plaque-by-ct-angiography-in-sle/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/progression-of-noncalcified-and-calcified-coronary-plaque-by-ct-angiography-in-sle/