Detection of carotid atherosclerosis in systemic lupus erythematosus and its relation to risk factors

ABSTRACT

To detect early atherosclerotic changes in SLE patients and to evaluate its relation to traditional cardiovascular risk factors and lupus-related factors. Forty female SLE patients were included in this study. Their age ranged from 20 to 63 years. All of them were subjected to full history taking, thorough clinical examination, laboratory investigations, disease activity assessment using SLE Disease Activity Index [SLEDAI] and assessment of SLE-related disease damage according to the Systemic Lupus International Collaborating Clinics [SLICC] damage index. Intima-media thickness [IMT] and carotid plaques were measured with carotid B-mode ultrasound. Risk factors associated with carotid plaques and IMT were determined. They included traditional cardiovascular risk factors, SLE-related disease factors and inflammation markers. Eighteen patients out of the 40 [45%] had plaques. Those patients were statistically significantly [p<0.05] older and had higher systolic and diastolic blood pressure, greater body mass index, higher levels of total cholesterol, low-density lipoprotein [LDL] cholesterol, fibrinogen and C-reactive protein [CRP] than patients without plaques. The patients with plaques had a statistically significant [p<0.05] longer disease duration, higher SLICC damage score and longer duration of prednisone use than those without plaques. The mean level of IMT of the CCA showed a statistically significant increase [P < 0.05] in SLE patients as compared to controls. The IMT was statistically highly significantly [p<0.001] as correlated with the age, CRP, and SLICC damage index. The prevalence of the plaques in the studied SLE patients was 45%. There were statistically significant differences between the patients with and those without plaques regarding disease-related factors [disease duration, SLICC damage score and duration of prednisone use] and inflammation markers [fibrinogen and C-reactive protein]. IMT of the CCA showed a statistically significant increase [P < 0.05] in SLE patients as compared to controls. The IMT was statistically highly significantly correlated with SLICC damage index. These findings show that SLE-related disease factors and inflammation markers are associated with carotid atherosclerosis in the SLE patients. SLE patients at risk of atherosclerosis should be examined by high resolution ultrasonography for identification of early stage atherosclerosis. Also, dampening of the inflammatory activity has a favorable impact on the progression of atherosclerosis in SLE patients