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Carotid atherosclerotic alterations in systemic lupus erythematosus patients treated at a Brazilian university setting

Rheumatology Service of the Hospital das Clínicas, Locomotor System Department of the School of Medicine at the Federal University of Minas Gerais, Belo Horizonte, MG, Brazil, rwtelles{at}ig.com.br, rwtelles{at}uol.com.br, Member of the Pronuclear Project - Brazilian Society of Rheumatology, SP, Brazil

Ccd Lanna

Rheumatology Service of the Hospital das Clínicas, Locomotor System Department of the School of Medicine at the Federal University of Minas Gerais, Belo Horizonte, MG, Brazil

GA Ferreira

Rheumatology Service of the Hospital das Clínicas, Locomotor System Department of the School of Medicine at the Federal University of Minas Gerais, Belo Horizonte, MG, Brazil

AJ Souza

Laboratory of Vascular Ultrasonography - Hermes Pardini Laboratory, MG, Brazil

TP Navarro

Vascular Surgery Service of the Hospital das Clínicas, the Federal University of Minas Gerais, Belo Horizonte, MG, Brazil

AL Ribeiro

Cardiology Service of the Hospital das Clínicas, Internal Medicine Department of the School of Medicine at the Federal University of Minas Gerais, Belo Horizonte, MG, Brazil

To determine the frequency of carotid plaque and intima-media thickness (IMT) in patients with systemic lupus erythematosus (SLE) and their association with risk factors in a Brazilian university setting. Carotid plaque and IMT were identified and measured by ultrasonography. Traditional risk factors and lupus-related factors were analysed. One hundred and seventy-two patients (women = 96%, age = 38 ± 11 years) were evaluated. The frequency of carotid plaque was 9.3%. The median (IR) IMT was 0.60 mm (0.54—0.71 mm). Age, family history (FH) of premature coronary disease, low-density cholesterol (LDL-c) >100 mg/dL, hypertriglyceridemia, diabetes, hypertension, smoking, postmenopause, number of risk factors, Framingham risk score, age at diagnosis, duration of lupus, mucocutaneous manifestations and duration of prednisone use were associated with plaque (P < 0.05), univariate analysis. Nephritis, immunosuppressive therapy, intravenous methylprednisolone and a higher average daily dose of prednisone were associated with the absence of plaque. Independent predictors of plaque were smoking (P = 0.004), LDL-c >100 mg/dL (P = 0.044), Framingham score (P = 0.006) and absence of immunosuppressive therapy (P = 0.032). There was an independent correlation between IMT and age (P < 0.001) and duration of prednisone use (P = 0.020). Subclinical atherosclerosis was associated with traditional risk and SLE-related factors, especially the absence of immunosuppressive therapy. The present study suggests that the levels of LDL-c should be kept under 100mg/dL in lupus. Lupus (2008) 17, 105—113.

Key Words: atherosclerosis • atherosclerotic plaque • carotid ultrasonography • systemic lupus erythematosus • traditional risk factors for coronary artery disease

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