Relationship between retinal microvascular impairment and subclinical atherosclerosis in SLE
Sara Ferrigno1, Paola Conigliaro2, Stefano Rizza3
1Rheumatology, Allergology and Clinical Immunology, Department of 'Medicina dei Sistemi', University of Rome Tor Vergata, Rome, Italy sara.ferrigno16@gmail.com.
Insights
Systemic lupus erythematosus (SLE) patients exhibit heightened cardiovascular risk and impaired retinal microvasculature. Optical coherence tomography angiography (OCTA) reveals retinal vascular density reduction, linked to cardiovascular risk factors like QRISK3 score and intima media thickness (IMT).
Area of Science:
- Cardiovascular disease research
- Ophthalmology
- Rheumatology
Background:
- Patients with Systemic Lupus Erythematosus (SLE) have an elevated cardiovascular (CV) risk and accelerated atherosclerosis compared to healthy controls (HC).
- Intima media thickness (IMT) is a marker of subclinical atherosclerosis, found to be higher in SLE patients than HCs.
- Retinal microvascular impairment, assessed via optical coherence tomography angiography (OCTA), is being investigated as a potential indicator of systemic vascular involvement in SLE.
Purpose of the Study:
- To investigate the relationship between retinal vascular impairment and intima media thickness (IMT) in patients with SLE.
- To evaluate retinal vascular changes as a marker of systemic vascular involvement in SLE.
- To identify predictors of cardiovascular risk in SLE patients using OCTA.
Main Methods:
- A cross-sectional study involving patients with SLE and HCs.
- Cardiovascular risk assessment using ACC/AHA guidelines, Framingham, and QRISK3 scores.
- Carotid ultrasound for IMT assessment and OCTA for retinal microvascular evaluation.
Main Results:
- SLE patients demonstrated higher CV risk indicators (triglycerides, TyG Index, ACC/AHA, Framingham scores) and reduced superficial and deep retinal vessel density (VD) compared to HCs.
- In SLE patients, reduced deep whole retinal VD correlated negatively with IMT, age, systolic blood pressure, QRISK3 Score, SLICC Damage Index, and apolipoprotein B.
- Multivariate analysis identified QRISK3 Score and IMT as independent risk factors for reduced retinal VD in SLE patients.
Conclusions:
- SLE patients exhibit lower retinal VD and higher CV risk indicators than HCs.
- QRISK3 Score and IMT are independent risk factors for retinal vascular impairment in SLE, suggesting OCTA's utility in detecting preclinical CV involvement.
- The Triglycerides-Glucose (TyG) Index may serve as a biomarker for CV risk in SLE patients.
Objectives:
Patients with SLE have higher cardiovascular (CV) risk compared with healthy controls (HC) and are characterised by accelerated atherosclerosis; intima media thickness (IMT), marker of subclinical atherosclerosis, is higher in patients with SLE than in HCs. Retinal microvascular impairment detected through optical coherence tomography angiography (OCTA) was investigated as a marker of systemic vascular involvement in SLE.The aim of the study was to evaluate the relationship between retinal vascular impairment and IMT in SLE.
Methods:
Cross-sectional study recruiting patients with SLE and HCs. Data of the study population were collected. CV risk was evaluated through the American College of Cardiology/American Heart Association (ACC/AHA) guidelines, Framingham and QRESEARCH risk estimator V.3 (QRISK3) scores. Both groups underwent OCTA and carotid ultrasound with IMT assessment.Statistical analysis was accomplished using Pearson/Spearman, t-test/Mann-Whitney or χ2 test. Variables statistically significant at univariate regression analysis were tested in an age-corrected and sex-corrected multivariate regression model.
Results:
43 patients with SLE and 34 HCs were recruited. Patients with SLE showed higher triglycerides (p=0.019), Triglycerides-Glucose (TyG) Index (p=0.035), ACC/AHA guidelines (p=0.001), Framingham Risk Scores (p=0.008) and a reduced superficial (p<0.001) and deep (p=0.005) whole retinal vessel density (VD) compared with HCs.In SLE univariate analysis, deep whole VD showed a negative correlation with IMT (p=0.027), age (p=0.001), systolic blood pressure (p=0.011), QRISK3 Score (p<0.001), Systemic Lupus International Collaborating Clinics Damage Index (p=0.006) and apolipoprotein B (p=0.021), while a positive correlation was found with female sex (p=0.029). Age-adjusted and sex-adjusted multivariate analysis confirmed QRISK3 Score (p=0.049) and IMT (p=0.039) to be independent risk factors for reduced retinal VD.
Conclusions:
Patients with SLE showed lower retinal VD and higher CV risk indicators compared with HCs. Among patients with SLE, QRISK3 Score and IMT were found to be independent risk factors for retinal vascular impairment, suggesting a role of OCTA in evaluating preclinical CV involvement in SLE. Moreover, TyG Index could represent a biomarker of CV risk in patients with SLE compared with HCs.
