Patients With SLE Have 4-Fold Higher Risk for Atherosclerotic Plaque Progression

Systemic lupus erythematosus increases the risk for subclinical atherosclerosis progression.

Compared with control participants, patients with systemic lupus erythematosus (SLE) have a higher risk for rapid progression of atherosclerotic plaques, which may be reduced by cardiovascular (CV) risk factor target attainment, according to study findings published in Rheumatology.

Compared with the general population, patients with SLE are at a 3-fold greater risk for subclinical atherosclerosis. In 2022, the European Alliance of Associations for Rheumatology (EULAR) guidelines recommended that patients with rheumatic and musculoskeletal diseases receive CV risk management.

The current study was designed to evaluate the effect of CV risk factor management on atherosclerotic plaques among patients with SLE.

Patients with SLE and age- and sex-matched control participants originally underwent vascular ultrasound between 2012 and 2013. A percentage of the original SLE and control cohorts underwent re-evaluation at 3- and 7-year follow-ups.

The outcomes of interest were reaching CVRF targets, as defined in the 2016 European Society of Cardiology (ESC) guidelines, and carotid and femoral artery plaque progression.

[W]e have shown that treating CVRFs to target can halt accelerated atherosclerosis in our cohort of patients who maintain low disease activity state, and has the potential to alter CVD burden in this population.

The SLE (n=86) and control (n=42) cohorts included 90.7% and 95.2% women, with a mean age of 44.4 and 44.9 years, and a median body mass index (BMI) of 24.7 and 25 at baseline, respectively. The groups were relatively well-balanced, except that the SLE vs control group had a greater smoking pack year history (P =.004) and used more antiplatelet agents (P <.001), antihypertensives (P =.024), and anticoagulants (P =.034).

Over the 7-year follow-up period, no new cases of atherosclerotic cardiovascular disease (CVD) were observed.

From baseline to follow-up, a similar percentage of patients with SLE and control participants attained the physical activity, blood pressure, and body weight targets; however, a greater percentage of control vs SLE participants tended to attain the smoking (P =.055) and the lipid targets (P =.0304). Overall, at follow-up, the SLE vs control group attained an average of 2.1 vs 2.3 targets, respectively (P =.347).

Plaque progression occurred among 37.2% of the SLE group and 19.0% of the control group (P =.037). Among the plaque progression subgroup, 26.7% of patients and 11.9% of control participants did not have plaques at baseline.

In the multivariate analysis, plaque progression was associated with SLE (odds ratio [OR], 4.16; 95% CI, 1.22-14.19; P =.023), age (OR, 1.12; 95% CI, 1.06-1.18; P <.001), and the sum of the CVRF targets attained (OR, 0.57; 95% CI, 0.32-0.99; P =.048).

Among patients with SLE, plaque progression was associated with disease duration (OR, 1.09; 95% CI, 1.02-1.17; P =.016) and the per-target sum of CVRF targets attained (OR, 0.56; 95% CI, 0.34-0.93; P =.026).

A major limitation of this study was the high loss to follow-up.

These data indicated that patients with SLE were more likely than the general population to have atherosclerotic plaque progression.

The study authors concluded, “[W]e have shown that treating CV [risk factors] to target can halt accelerated atherosclerosis in our cohort of patients who maintain low disease activity state, and has the potential to alter CVD burden in this population.”

This article originally appeared on Rheumatology Advisor


Papazoglou N, Kravvariti E, Kostantonis G, Sfikakis PP, Tektonidou MG. The impact of traditional cardiovascular risk factor control on 7-year follow-up atherosclerosis progression in systemic lupus erythematosus. Rheumatology. Published online April 22, 2023. doi:10.1093/rheumatology/kead184