Progression of subclinical and clinical cardiovascular disease in a UK SLE cohort: the role of classic and SLE-related factors.

Objectives We aimed to describe the rate and determinants of carotid plaque progression and the onset of clinical cardiovascular disease (CVD) in a UK SLE cohort. Methods Female SLE patients of white British ancestry were recruited from clinics in the North-West of England and had a baseline clinical and CVD risk assessment including measurement of carotid intima media thickness (CIMT) and plaque using B mode Doppler ultrasound. Patients were followed up (>3.5 years after baseline visit) and had a repeat carotid Doppler to assess progression of plaque and CIMT. Clinical CVD events between visits were also noted. Results Of 200 patients with a baseline scan, 124 (62%) patients had a second assessment at a median (IQR) of 5.8(5.2, 6.3) years follow-up. New plaque developed in 32 (26%) (4.5% per annum) patients and plaque progression was observed in 52 (41%) patients. Factors associated with plaque progression were older age (OR 1.13; 95%CI 1.06, 1.20), anti-cardiolipin (OR 3.36; 1.27, 10.40) and anti-Ro (OR 0.31; 0.11, 0.86) antibodies. CVD events occurred in 7.2% over 5.8 years compared to 1.0% predicted using the Framingham risk score (P<0.001). Higher triglycerides (OR 3.6; 1.23, 10.56), cyclophosphamide exposure ‘ever’ (OR 16.7; 1.46, 63.5) and baseline SDI score (OR 9.62; 1.46, 123) independently predicted future CVD events. Conclusion Accelerated atherosclerosis remains a major challenge in SLE disease management. A more comprehensive approach to CVD risk management taking into account disease factors such as severity and anti-cardiolipin antibody status may be necessary to improve CVD outcomes in this high-risk population.