Carotid plaques in patients with long-term lupus nephritis.
OBJECTIVE
To evaluate the prevalence of carotid plaques in patients with long-term lupus nephritis (LN).


METHODS
Intima-media thickness (IMT) and carotid plaques were evaluated with ultrasound in 75 patients after a follow-up of LN of 158+/-106 months and in 75 sex -and age-matched controls. Traditional and non-traditional atherosclerotic risks factors were also tested.


RESULTS
IMT was not different between LN patients and controls, but 18% of LN patients had carotid plaques in comparison to 2.6% of controls (p=0.004). The LN patients more frequently had hypertension (p=0.0001), hypercholesterolemia (p=0.0001), were overweight (p=0.009), in menopause (p=0.01) than controls. More frequently, LN patients with carotid plaques had renal insufficiency (p=0.03), longer duration of lupus (p=0.05), anti-phospholipid antibodies (p=0.018), high C-reactive protein (p=0.03), high reactive oxygen species (p=0.001) than those without plaques. Patients with plaques were older (p=0.000001), in menopause (p=0.000001) and more frequently had cardio-vascular accidents during observation (p=0.02). The time of exposure to pathological values of systolic and diastolic blood pressure was longer (p=0.000001) and the percentage of pathological values of these variables during the follow-up was higher (p=0.000001) in patients with carotid plaques. At multivariate analysis, older age (p=0.0025), longer time of exposure to pathological values of blood pressure (p=0.015) and of cholesterol (p=0.04) were independent predictors of carotid plaques.


CONCLUSIONS
Carotid plaques were more frequently found in LN patients than in controls. Although inflammatory markers and lupus related factors may contribute to the development of atherosclerosis, only traditional risk factors such as age, hypertension and hypercholesterolemia were the independent predictors.
Divisione di Nefrologia e Dialisi, Fondazione Ospedale Maggiore, Mangiagalli, Regina Elena, Milano, Italy.
Beniamina
B
Gallelli
Larry
L
Burdick
Silvana
S
Quaglini
Giovanni
G
Banfi
Cristina
C
Novembrino
Fabrizia
F
Bamonti
Piergiorgio
P
Messa
Gabriella
G
Moroni
D000328:Adult; D017152:Antibodies, Antiphospholipid / Q000097:blood; D001794:Blood Pressure; D002097:C-Reactive Protein / Q000378:metabolism; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology* / Q000378:metabolism; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000378:metabolism; D008181:Lupus Nephritis / Q000453:epidemiology* / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D015995:Prevalence; D017382:Reactive Oxygen Species / Q000378:metabolism; D012307:Risk Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D018608:Ultrasonography, Doppler
D017152:Antibodies, Antiphospholipid; D017382:Reactive Oxygen Species; D002097:C-Reactive Protein