title: Duplex study of the carotid and femoral arteries of patients with systemic lupus erythematosus: a controlled study.
abstract: OBJECTIVE
  To identify atherosclerosis in the common carotid (CCA) and common femoral arteries (CFA) of patients with systemic lupus erythematosus (SLE) and matched controls.
  
  
  METHODS
  Fifty-one consecutive patients with SLE were enrolled in the study. Controls were matched by age, sex, ethnicity, and atherosclerosis risk factors. All patients and controls underwent ultrasonic biopsy (U-B) of the CFA and CCA, a noninvasive screening technique that detects early atherosclerotic plaques and changes. The U-B features were classified and scored as follows: class A: normal (score 0); class B: interface disruption (score 2); class C: intima-media granulation (score 4); class D: plaque without hemodynamic disturbance (score 6); class E: stenotic plaque (score 8); and class F: plaque with symptoms (score 10). Total score was calculated. Classes A and B indicate an intact media; classes D to F point to a significant medial involvement; class C signifies a borderline lesion with a potential for regression to normal or progression to a plaque.
  
  
  RESULTS
  Mean ages were 40.5 years for SLE patients and 41 years for controls (p = 0.6). Ninety-six percent of the patients and controls were women. The mean disease duration of SLE was 8.65 years. Frequencies of risk factors among the SLE patients compared to controls were hypertension (30% vs 24%), smoking (23% vs 24%), and dyslipidemia (17.7% vs 17%). No patient had diabetes mellitus or family history of cardiovascular disease. A 3.17-fold increased rate of atherosclerotic plaques was detected in the SLE patients compared with controls (95% CI 1.08-10.9). Twenty-eight percent of SLE patients had at least a single class D-F lesion in one of the 4 vessels tested, compared with 10% in the control group (p = 0.02). In addition, the mean total U-B score of the SLE patients was significantly higher than that of the controls (5.65 vs 3.14; p = 0.02). Univariate analyses showed that the development of plaques in SLE was associated with a history of ischemic heart disease, hypertension, cardiovascular accident, and anemia. Multivariate analysis found plaques to be strongly associated with age, particularly in those older than 50 (OR 2.66, p = 0.000).
  
  
  CONCLUSIONS
  Patients with SLE have a high rate of atherosclerotic changes compared to controls. The development of atherosclerosis is strongly associated with age.
authors.affiliation: Rheumatic Diseases Unit, Soroka University Medical Center, Ben Gurion University, Beer-Sheva, Israel.
authors.forename: Talia
authors.initials: T
authors.lastname: Wolak
authors.forename: Evguenia
authors.initials: E
authors.lastname: Todosoui
authors.forename: Gabriel
authors.initials: G
authors.lastname: Szendro
authors.forename: Arkadi
authors.initials: A
authors.lastname: Bolotin
authors.forename: Bat-Sheva
authors.initials: BS
authors.lastname: Jonathan
authors.forename: Daniel
authors.initials: D
authors.lastname: Flusser
authors.forename: Dan
authors.initials: D
authors.lastname: Buskila
authors.forename: Shaul
authors.initials: S
authors.lastname: Sukenik
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abu-Shakra
mesh_terms: D000328:Adult; D001161:Arteriosclerosis / Q000209:etiology / Q000473:pathology*; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D012307:Risk Factors; D012720:Severity of Illness Index; D014463:Ultrasonography