Background: Frailty is independently associated with an increased risk of cardiovascular disease in the general population. Lupus International Collaborating Clinics (SLICC)- Frailty Index (SLICC-FI) has been associated with adverse outcomes and mortality in SLE [1].

Objectives: Herein, we assess the association between frailty and subclinical atherosclerosis, an independent predictor of cardiovascular disease in SLE.

Methods: This cross-sectional study consists of 202 eligible SLE patients and 115 age- and sex-matched healthy controls who underwent carotid and femoral ultrasound examination in the Cardiovascular Research laboratory of our Rheumatology Unit. Demographic, clinical and laboratory parameters were collected at the time of ultrasound examination and frailty was assessed by the Lupus International Collaborating Clinics-Frailty Index (SLICC-FI). Cardiovascular disease risk (CVR) was evaluated by the Systematic COronary Risk Evaluation (SCORE) model and classified as low-moderate, high, and very high. Univariate and multivariate logistic regression analysis were performed to assess associations between several clinical and laboratory parameters, including SLICC-FI, and atherosclerotic plaque presence in SLE, after adjustment for traditional and disease-related CVRFs. The covariates included in the models were preselected based on the relevant literature.

Results: Vascular ultrasound examination revealed atherosclerotic plaques presence in 52 (25.7%) of 202 patients [89.1% female, mean (± SD) age 46.7 ±12.6] vs 19 (16.5 %) of 115 healthy controls (p=0.05). In total, 20.8% of SLE patients had carotid artery plaques and 17.3% had femoral artery plaques. After adjusting for age, sex and traditional CVRFs incorporated in the SCORE model, SLE patients had 2.5-fold higher risk for carotid plaques versus healthy controls [Odds Ratio (OR)=2.57, 95% CI 1.26- 5.21, p=0.009]. The median (IQR) SLICC-FI was 0.08 (0.06) and 39 (19.3%) patients were classified as robust, 91 (45%) as relatively less fit, 59 (29.2%) as least fit, and 13 (6.4%) as frail. In the univariate analysis, the presence of either carotid or femoral plaques was significantly associated with age (p<0.001), disease duration (p=0.002), systolic blood pressure (p=0.018), smoking (p=0.003), hypertension (p=0.003), dyslipidemia (p=0.011), SCORE (p<0.001), CVR class (p<0.001), and SLICC-FI (p=0.001). After adjustment for traditional CVR factors and SLE-related characteristics, CVR class (OR=5.16, 95% CI 2.75- 9.70, p<0.001) and SLICC-FI (OR=1.06, 95% CI 1.00- 1.12, p=0.03, per 0.01 increase) were found to be the only independent predictors for plaque presence in multivariate analysis.

Conclusion: SLICC-Frailty Index (FI) is independently associated with subclinical atherosclerotic plaques in SLE patients and could serve as a useful clinical tool to assess CVR in SLE patients. Identification of frail populations and early introduction of lifestyle and heath interventions may help to reduce cardiovascular disease burden in SLE.

REFERENCES: [1] Legge A, Malone A, Hanly JG. External validation of the Systemic Lupus International Collaborating Clinics Frailty Index as a predictor of adverse health outcomes in systemic lupus erythematosus. Rheumatology (Oxford). 2022 May 5;61(5):1919-1927.

Acknowledgements: NIL.

Disclosure of Interests: None declared.