Background: Systemic lupus erythematosus (SLE) is a prototype autoimmune disease, with increased cardiovascular (CV) burden [1]. It is well established that patients with SLE exhibit increased arterial stiffness and accelerated subclinical atherosclerosis, that could explain their increased CV risk [2,3]. Microvascular dysfunction, however, is considered an important component in the pathophysiology of CV disease. Recently it was shown that retinal microvascular impairment may be associated with CV risk in SLE patients, however, there is lack of data regarding the effect of multiple target organ damage (TOD) on CV health.

Objectives: The aim of our study was i) to evaluate the presence of microvascular changes in SLE and ii) to investigate whether accumulation of microvascular TOD could serve as a predictor of increased CV risk.

Methods: Patients who met the Systemic Lupus International Collaborating Clinics classification criteria for SLE were recruited from the Rheumatology Outpatient Unit, while individuals in the control group were recruited from the Hypertension Outpatient Unit and the community. To evaluate microcirculation, all participants underwent i) evaluation of skin microvascular perfusion using laser speckle contrast analysis (LASCA), ii) fundoscopy using a non-mydriatic fundus camera, iii) indirect assessment of myocardial perfusion through Subendocardial viability ratio (SEVR) via applanation tonometry and iv) evaluation of urinary albumin excretion (urine albumin-to-creatinine ratio, UACR) in a random urine sample. CV risk was calculated using the QResearch Risk Estimator version 3 (QRISK3). A p value <0.05 was considered as statistically significant.

Results: Eighty-six individuals (47 SLE patients and 39 controls) were studied. No differences between groups were observed in baseline characteristics. SLE patients demonstrated impaired skin microvascular reactivity (p<0.01), retinal arteriolar narrowing (p<0.01) and higher UACR levels (p<0.05) compared to the control group. Moreover, patients with SLE had significantly higher QRISK3 score [6.4 (2.7 – 11.3) vs 1.6 (1.0 – 4.3) respectively, p<0.001] and a greater chance for microvascular dysfunction (OR:4.1, 95%CI: 1.7 – 10.2) compared to the control group. In the SLE group, increase in the number of TOD correlated with increased QRISK3 score (p<0.01) and individuals with multiple TOD (Figure 1) exhibited higher QRISK3 (p<0.05).

Conclusion: To our knowledge this is the first study investigating the presence of various microvascular TOD in SLE patients compared to controls. We showed that patients with SLE exhibit a significantly greater number of TOD that could partially explain the increased CV risk that these patients bare. Accumulation of TOD was associated with a higher estimated CV risk among SLE individuals.

REFERENCES: [1] Bello N, Meyers KJ, Workman J, Hartley L, McMahon M. Cardiovascular events and risk in patients with systemic lupus erythematosus: Systematic literature review and meta-analysis. Lupus. 2023;32(3):325–41.

[2] Panopoulos S, Drosos GC, Konstantonis G, Sfikakis PP, Tektonidou MG. Generic and disease-adapted cardiovascular risk scores as predictors of atherosclerosis progression in SLE. Lupus Sci Med. 2023;10(1).

[3] Triantafyllias K, Thiele LE, Cavagna L, Baraliakos X, Bertsias G, Schwarting A. Arterial Stiffness as a Surrogate Marker of Cardiovascular Disease and Atherosclerosis in Patients with Arthritides and Connective Tissue Diseases: A Literature Review. Diagnostics 2023, Vol 13, Page 1870. 2023;13(11):1870.

Figure 1.

Cardiovascular risk score according to microvascular target organ damage.

QRISK3: QResearch Risk Estimator version 3

Acknowledgements: NIL.

Disclosure of Interests: None declared.