Preclinical vascular disease in systemic lupus erythematosus and primary antiphospholipid syndrome.
OBJECTIVE
To determine the prevalence of preclinical vascular disease and associated risk factors in patients with systemic lupus erythematosus (SLE) or primary antiphospholipid syndrome (APS).


METHODS
We consecutively studied 70 SLE patients and 25 primary APS patients without clinical coronary artery disease. The control group included 40 healthy women. Carotid ultrasound was performed and the intima-media wall thickness (IMT) and presence of plaque was investigated in all patients and controls. Traditional vascular risk factors and SLE-disease and treatment related factors were also analysed.


RESULTS
SLE patients had a higher prevalence of traditional atherosclerosis risk factors: hypertension (P<0.005) and dyslipidaemia (P<0.05) and higher levels of total cholesterol (P = 0.03), triglycerides (P = 0.004) and apolipoprotein B (P = 0.04). The prevalence of carotid plaque was higher and appeared earlier in SLE patients than in the primary APS patients or controls (P<0.001). The IMT was similar in the three groups. SLE patients with secondary APS had a higher prevalence of carotid plaque than patients with primary APS (37.5% vs 8%, P = 0.03). The presence of plaque in SLE patients was associated with a higher SLICC score (2.40 +/- 1.78 vs 1.02 +/- 1.18, P = 0.002), higher ECLAM score (3.10 +/- 2.32 vs 1.84 +/- 1.59, P = 0.02) and older age (47.3 +/- 8.44 vs 37.38 +/- 11.28, P = 0.003) at the time of carotid ultrasound study.


CONCLUSIONS
Plaque prevalence in patients with primary APS is similar to that of controls and inferior to that of SLE patients with secondary APS. SLE patients have a high prevalence of early carotid atherosclerosis that is associated with cumulative disease damage and disease activity.
Jiménez
Sònia
S
Servicio de Enfermedades Autoinmunes, ICMiD, Hospital Clínic, C/Villaroel 170, 08036 Barcelona, Spain.
García-Criado
M Angels
MA
Tàssies
Dolors
D
Reverter
Joan Carles
JC
Cervera
Ricard
R
Gilabert
M Rosa
MR
Zambón
Daniel
D
Ros
Emilio
E
Bru
Concepció
C
Font
Josep
J
D000328:Adult; D000367:Age Factors; D016736:Antiphospholipid Syndrome / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D001055:Apolipoproteins B / Q000097:blood; D001161:Arteriosclerosis / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000097:blood / Q000150:complications / Q000000981:diagnostic imaging; D002784:Cholesterol / Q000097:blood; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000150:complications; D006973:Hypertension / Q000097:blood / Q000150:complications; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging; D008875:Middle Aged; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D014463:Ultrasonography; D014652:Vascular Diseases / Q000097:blood / Q000150:complications* / Q000000981:diagnostic imaging
D001055:Apolipoproteins B; D014280:Triglycerides; D002097:C-Reactive Protein; D002784:Cholesterol