Longitudinal study on premature atherosclerosis in patients with systemic lupus erythematosus

To determine risk factors of accelerated atherosclerosis and progression of intima-media thickness (IMT) in patients with systemic lupus erythematosus (SLE).

74 SLE patients, age ranging from 13 to 69 years, and 74 age- and sex-matched controls were included. IMT of the common carotid artery was determined by B-mode ultrasound imaging. Traditional risk factors for atherosclerosis and disease-related factors were recorded. Cardiovascular risk was estimated using systematic coronary risk evaluation (SCORE). Markers of inflammation (C-reactive protein, CRP) and endothelial activation (thrombomodulin, vascular cell adhesion molecule-1, and von Willebrand factor) were determined. Measurements were repeated in 52 patients after a follow-up of 32+/-7 months.

IMT was increased in SLE patients compared to controls. Prevalence of smoking and hypertension, use of lipid-lowering drugs and SCORE were higher in patients, as well as levels of CRP and markers of endothelial activation. The age-related increase in IMT was significantly higher in patients than in controls. In multivariate analysis, age and disease duration was independently related to IMT. Increase in IMT during follow-up was related to age only.

The age-related increase in IMT is higher in SLE, indicating that atherosclerosis is accelerated in SLE patients. This is mainly due to disease-related risk factors, as disease duration was independently associated with IMT.