Background/Purpose:

Women with SLE have increased rates of subclinical atherosclerosis and cardiovascular (CV) events.  We investigated which risk factors may be significant in the rate of subclinical atherosclerosis progression, as measured by AS, in women with (cases) and without (controls) SLE.

Methods:

Baseline data were collected on cases and controls including demographics, self-reported and measured Framingham CV risk factors.  SLE factors collected included the modified SLICC/ACR-DI Damage Index (SDI) (excluding CV outcomes).  AS was measured by electron beam or multidimensional computed tomography at baseline and at 1 follow-up visit in the Study of Lupus Vascular and Bone Long-Term Endpoints (SOLVABLE).  A high risk AS was defined as AS>100 and progression in AS at follow-up was defined as an AS>100 and an increase of >10% compared to baseline. A low risk AS was defined as AS<100.  Univariate regression models of AS with risk factors were examined, and also adjusted for age. Presence of hypertension (HTN) was defined as systolic blood pressure (BP) ≥ 140 or diastolic BP ≥ 90 or on anti-HTN medication.

Results:

At the baseline visit in 142 cases, their age was 43.3 ± 9.9 yrs, disease duration was 12.0 ± 8.4 yrs, SLEDAI was 3.8 ± 3.5, SDI was 1.5 ± 1.6 (mean ± SD).  Imaging data with AS at baseline and follow-up were available on 106 cases; baseline AS scans were not performed in 36 cases.  In 120 controls, their age was 46.7 ± 10.1 yrs (mean ± SD).  Imaging data with AS at baseline and follow-up were available on 118 controls; 2 were missing baseline AS measurements. Mean ± SD follow-up time between imaging studies in 106 cases and 118 controls was 3.26 ± 0.35 yrs and 3.37 ± 0.41 yrs, respectively.  Follow-up time was slightly different between cases and controls (p=0.05). 

In 106 cases, 67 (63%) had low risk AS at baseline and at follow-up, 11 (10.4%) had low risk AS at baseline with progression at follow-up, 4 (3.8%) with high risk AS at baseline regressed to low risk at follow-up, and 0 with low risk AS at baseline progressed at follow-up.

In 118 controls, 87 (73%) had low risk AS at baseline and at follow-up, 7 (5.9%) had low risk AS at baseline with progression at follow-up, 2 (1.7%) with high risk AS at baseline regressed to low risk at follow-up, and 0 with high risk AS at baseline progressed at follow-up.

In the women with SLE, AS progression was univariately associated with HTN, current smoking, older age, and higher SDI. After adjustment, only increased SDI remained significant (OR 1.60, 95% CI 1.22-2.16). In controls, AS progression was univariately associated with HTN, current smoking status, older age, and higher BMI. After adjustment, only current smoking status remained significant (OR 6.65, 95% CI 1.55-31.29).

Conclusion:

In cases and controls, traditional CV risk factors are univariately associated with the progression of subclinical atherosclerosis as measured by AS. In cases, SLE damage is significantly associated with progression. While aging mediates the effect of many traditional CV risk factors for AS progression in women with and without SLE, increased risk due to SLE damage is independent of age. Further investigation with multivariate models is needed.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/women-with-systemic-lupus-erythematosus-sle-may-have-different-predictors-of-risk-for-progression-of-aorta-calcium-as-than-women-without-sle/