Relation of Carotid Intima-Media Thickness and Plaque With Incident Cardiovascular Events in Women With Systemic Lupus Erythematosus

• Published in: The American journal of cardiology Vol. 112; no. 7; pp. 1025 - 1032
• Main Authors: Kao, Amy H., MD, MPH, MS, Lertratanakul, Apinya, MD, Elliott, Jennifer R., MD, Sattar, Abdus, PhD, Santelices, Linda, MS, Shaw, Penny, RN, Birru, Mehret, MD, PhD, Avram, Zheni, MD, Thompson, Trina, DrPH, Sutton-Tyrrell, Kim, DrPH, Ramsey-Goldman, Rosalind, MD, DrPH, Manzi, Susan, MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2013; Elsevier Limited
• Subjects: Adult; Angina Pectoris - complications; Angioplasty, Balloon, Coronary; Asymptomatic Diseases; Cardiovascular; Cardiovascular disease; Cardiovascular Diseases - complications; Carotid Arteries - diagnostic imaging; Carotid Artery Diseases - complications; Carotid Artery Diseases - diagnostic imaging; Carotid Intima-Media Thickness; Cholesterol; Coronary Artery Bypass; Drug therapy; Female; Heart Arrest - complications; Humans; Ischemic Attack, Transient - complications; Longitudinal Studies; Lupus; Lupus Erythematosus, Systemic - complications; Middle Aged; Myocardial Infarction - complications; Plaque, Atherosclerotic - complications; Plaque, Atherosclerotic - diagnostic imaging; Prospective Studies; Risk Assessment; Risk Factors; Stroke - complications; Pittsburgh Pennsylvania
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2013.05.040

Patients with systemic lupus erythematosus (SLE) are at increased risk for cardiovascular (CV) disease. The aim of this study was to investigate the association between subclinical CV disease as measured by carotid intima-media thickness (IMT) and plaque using B-mode carotid ultrasound and incident CV events in a combined cohort of female patients with SLE. This was a prospective, 2-center observational study of 392 adult women with SLE and no previous CV events with a mean 8 years of follow-up. Incident CV events confirmed by clinicians were defined as angina, myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass graft, fatal cardiac arrest, transient ischemic attack, and cerebrovascular accident. Incident hard CV events excluded angina and transient ischemic attack. The mean age was 43.5 years, and most patients were Caucasian (77.3%). During follow-up, 38 patients had incident CV events, and 17 had incident hard CV events. Patients with incident hard CV events had higher mean carotid IMT (0.80 vs 0.64 mm, p <0.01) and presence of carotid plaque (76.5% vs 30.4%, p <0.01) compared with those without incident hard CV events. Baseline carotid IMT and presence of plaque were predictive of any incident hard CV event (hazard ratio 1.35, 95% confidence interval 1.12 to 1.64, and hazard ratio 4.26, 95% confidence interval 1.23 to 14.83, respectively), independent of traditional CV risk factors and medication use. In conclusion, in women with SLE without previous CV events, carotid IMT and plaque are predictive of future CV events. This suggests that carotid ultrasound may provide an additional tool for CV risk stratification in patients with SLE.