medwireNews: The overall burden of vascular plaque measured on ultrasound scans is significantly associated with future risk for cardiovascular disease (CVD) events in people with systemic lupus erythematosus (SLE), study findings indicate.
Writing in Rheumatology, Anisur Rahman (University College London, UK) and colleagues explain that at present, “[t]he use of carotid ultrasound to optimise CVD prediction is recommended as part of CVD risk evaluation in autoimmune rheumatic diseases,” but it is not clear “how best to use vascular ultrasound information to manage CVD risk in patients with SLE.”
To address this gap, the team evaluated overall plaque burden – assessed by the number of carotid and common femoral artery bifurcations with plaque and total plaque area (TPA) – in 100 patients with SLE (98% women), of whom 36% had plaque at baseline.
A total of 7% of these people developed CVD during an average follow-up of 7.5 years, including five people with coronary events and two with lacunar strokes.
Rahman and team found that the 15 people with 3–4 bifurcations with plaque at baseline had significantly higher rates of CVD events than the 85 people with 0–2 bifurcations (26.7 vs 3.5%). Area under the receiver operating characteristic curve (AUC) analysis demonstrated that the presence of at least one bifurcation with plaque at baseline had an accuracy of 72.4% for predicting new CVD events.
Similarly, CVD event rates were significantly higher among people with a TPA of more than versus less than 16 mm2 at baseline, at 16.1% of 31 individuals versus 2.9% of 69. At this cutoff TPA had an accuracy of 75.9% for predicting CVD risk.
By comparison, AUC analysis of the QRISK3 10-year risk score for myocardial infarction and stroke, which takes into account SLE, corticosteroid use, chronic renal impairment, and other risk factors, showed “considerably lower” accuracy for predicting CVD events, at 64.7%, says the team.
“The very strong predictive value of TPA and number of bifurcations with plaque […] leads us to suggest that vascular ultrasound scanning may have a place in assessing CVD risk in patients with SLE,” write Rahman et al.
They also showed that low baseline complement C3 levels (<0.88 g/L) and longer disease duration were significant predictors of CVD risk. A disease duration cutoff of 14 years identified a high-risk subgroup of 45 patients that included six of the seven CVD events, and 20 of these people also had TPA of more than 16 mm2.
“Given our findings, we suggest that disease duration should be a third criterion for scanning such that patients with disease duration > 14 years should be offered a scan of both carotid and both femoral bifurcations with measurement of TPA,” say the study authors.
They caution, however, that their results require validation in further studies.
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