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Anticardiolipin antibody titre and plasma homocysteine level independently predict intima media thickness of carotid arteries in subjects with idiopathic antiphospholipid antibodies

Lupus Research Unit, St Thomas' Hospital, London, UK; 75 Canterbury House, Royal Street, London SE1 7EH UK,paxmes{at}aol.com

A Margarita

Angiology Unit, Department of Pathology, Cardarelli Hospital, Naples, Italy

J Delgado Alves

Bloomsbury Centre for Rheumatology, University College London, London, UK

C Tommasino

Chemical Pathology, S Gennaro Hospital, Naples, Italy

L Iannaccone

V Brancaccio

Coagulation Unit, Department of Haematology, Cardarelli Hospital, Naples, Italy

This study evaluated whether IgG anticardiolipinantibody (aCL) titre and traditional risk factors for atherosclerosis bore any relationship to the intima media thickness (IMT) of carotid arteries of patients with idiopathic antiphospholipid antibodies (aPL). IMT was assessed by high-resolution sonography at the common carotid, carotid bifurcation and internal carotid in 42 (13 male, 29 female, mean age 31 10 years) aPL subjects, 29 with primary thrombotic antiphospholipid syndrome and 13 with persistence of aPL in the absence of any underlying disorder. In the same subjects the following were measured: plasma fibrinogen (FNG), von Willebrand factor (vWF), plasminogen activator inhibitor (PAI), homocysteine (HC), total cholesterol (CHO), triglycerides (TG), high density and low density lipoprotein (HDL and LDL), platelet numbers and aCL of IgG and IgM isotype. IMT of the internal carotid was greater in males than females (0.48±0.03 vs 0.39±0.01 mm, P = 0.02). IMT of the carotid bifurcation was greater in thrombotic than nonthrombotic subjects (0.50 0.02 vs 0.42 0.02 mm, P = 0.04). By simple regression, IMT of the common carotids correlated with age (P < 0.0001) IgG aCL titre (P = 0.001), FNG (P = 0.006), LDL (0.01), CHO (0.02) and PAI (P = 0.02). IMT of the carotid bifurcation correlated with age (P = 0.002), IgG aCL titre (P = 0.0002), FNG (P = 0.0001), HC (P = 0.009), CHO (P = 0.02), vWF (P = 0.01) and number of thrombotic events (P = 0.03). IMT of the internal carotids correlated with age (P = 0.002), IgG aCL titre (P = 0.0001), FNG (P = 0.0008), PAI (P = 0.002) and HC (P = 0.01). By stepwise multiple regression analysis, IgG aCL titre independently predicted IMT at all carotid segments examined (P always < 0.005). In addition, plasma FNG and HC also resulted independent predictors of IMT at the carotid bifurcation (P = 0.001 and P < 0.0001, respectively) and internal carotid (P = 0.03 and P < 0.0001, respectively). These data strongly support an atherogenic role for IgG aCL in patients with aPL. Measurement of plasma HC and FNG may help define aPL subjects at higher vascular risk who may require lowering of HC and FNG by vitamin and/or pharmacologic intervention. Lupus (2002) 11, 208–214.

Key Words: anticardiolipin antibody • homocysteine • fibrinogen • intima media thickness • athero-sclerosis

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