Preclinical vascular disease in systemic lupus erythematosus and primary antiphospholipid syndrome

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Abstract
Objective. To determine the prevalence of preclinical vascular disease and associated risk factors in patients with systemic lupus erythematosus (SLE) or primary antiphospholipid syndrome (APS). Methods. We consecutively studied 70 SLE patients and 25 primary APS patients without clinical coronary artery disease. The control group included 40 healthy women. Carotid ultrasound was performed and the intima-media wall thickness (IMT) and presence of plaque was investigated in all patients and controls. Traditional vascular risk factors and SLE-disease and treatment related factors were also analysed. Results. SLE patients had a higher prevalence of traditional atherosclerosis risk factors: hypertension (PPP = 0.03), triglycerides (P = 0.004) and apolipoprotein B (P = 0.04). The prevalence of carotid plaque was higher and appeared earlier in SLE patients than in the primary APS patients or controls (Pvs 8%, P = 0.03). The presence of plaque in SLE patients was associated with a higher SLICC score (2.40 ± 1.78 vs 1.02 ± 1.18, P = 0.002), higher ECLAM score (3.10 ± 2.32 vs 1.84 ± 1.59, P = 0.02) and older age (47.3 ± 8.44 vs 37.38 ± 11.28, P = 0.003) at the time of carotid ultrasound study. Conclusion. Plaque prevalence in patients with primary APS is similar to that of controls and inferior to that of SLE patients with secondary APS. SLE patients have a high prevalence of early carotid atherosclerosis that is associated with cumulative disease damage and disease activity.