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Premature aortic atherosclerosis in systemic lupus erythematosus: a controlled transesophageal echocardiographic
Carlos A Roldan1, Joseph Joson, Janeen Sharrar
1Department of Medicine, Cardiology Division, University of New Mexico School of Medicine and New Mexico VA Health Care System, Albuquerque, New Mexico 87108, USA. croldan@salud.unm.edu
Insights
Aortic atherosclerosis (AA) is prevalent in systemic lupus erythematosus (SLE) patients. Later SLE diagnosis and cyclophosphamide therapy influence AA development.
Area of Science:
- Cardiovascular Medicine
- Rheumatology
- Medical Imaging
Background:
- Systemic lupus erythematosus (SLE) is associated with premature atherosclerosis in carotid and coronary arteries.
- Data regarding aortic atherosclerosis (AA) in SLE patients remain limited.
Purpose of the Study:
- To determine the prevalence of aortic atherosclerosis (AA) in patients with SLE.
- To identify clinical factors associated with AA in SLE patients using multiplane transesophageal echocardiography (TEE).
Main Methods:
- Forty-seven SLE patients and 21 healthy controls underwent clinical, laboratory, and TEE evaluations.
- AA was defined by aortic intima media thickness (IMT) > 0.86 mm or plaques.
- TEE studies were interpreted by an experienced observer blinded to clinical data.
Main Results:
- The prevalence of abnormal aortic IMT, plaques, or both was significantly higher in SLE patients compared to controls (43% vs 14%).
- Later age at SLE diagnosis was a positive independent predictor of AA (OR 1.12 per year).
- Cyclophosphamide therapy was a negative independent predictor of AA (OR 0.186), indicating a reduced likelihood of developing AA.
Conclusions:
- Aortic atherosclerosis (AA) is common in young SLE patients.
- Later SLE diagnosis increases AA risk, while cyclophosphamide therapy is protective.
- Early SLE diagnosis and aggressive immunosuppressive therapy may be crucial for managing atherosclerosis in SLE.
Objective:
Premature carotid and coronary atherosclerosis are common in systemic lupus erythematosus (SLE), but data on aortic atherosclerosis (AA) are limited. Thus, using multiplane transesophageal echocardiography (TEE), we sought to determine the prevalence and clinical correlates of AA in patients with SLE.
Methods:
Forty-seven patients with SLE (44 women, age 38 +/- 12 years) and 21 healthy controls (19 women, age 34 +/- 12 years) underwent clinical and laboratory evaluations and TEE to assess AA defined as aortic intima media thickness (IMT) > 0.86 mm or plaques as > 50% focal IMT as compared with surrounding walls. TEE studies were interpreted by an experienced observer unaware of subjects' clinical data.
Results:
The prevalence of abnormal aortic IMT, plaques, or both lesions was higher in patients as compared to controls (37%, 23%, and 43% vs 14%, 0%, and 14%, respectively, all p
Conclusion:
AA is common in young patients with SLE and is predicted by a later age at diagnosis of SLE, but is negatively correlated with cyclophosphamide therapy. Thus, early diagnosis and more aggressive immunosuppressive therapy may be required to decrease the development and progression of atherosclerosis in patients with SLE.
