Background: Cardiovascular disease (CVD) remains one of the leading causes of morbidity and mortality in Systemic Lupus Erythematosus (SLE). The 2022 EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including SLE and antiphospholipid syndrome (APS) [1] emphasize the need for meticulous assessment and control of modifiable cardiovascular risk factors (CVRFs) and the significance of minimal disease activity.

Objectives: We aimed to compare plaque progression between patients with SLE and age/sex-matched healthy controls and identify predictors of progression of subclinical atherosclerosis and the occurrence of cardiovascular events in SLE during a 10-year follow-up.

Methods: Ten years after their initial vascular ultrasound assessment, 115 patients with SLE and 115 age- and sex-matched healthy controls without CVD events or diabetes mellitus history, were invited for a subsequent ultrasound examination to identify any new carotid plaque development. Ninety-five eligible patients and 71 controls were included in the 10-year follow-up study. Employing logistic regression analysis and adjusting for potential confounders, we sought to investigate independent predictors of 10-year follow-up atherosclerotic plaque progression in SLE, including multiple clinical, laboratory and treatment parameters, baseline carotid plaque presence, different durations of Lupus Low Disease Activity State (LLDAS) and DORIS complete clinical remission, e.g. 100%, 75% and 50% of the follow-up time over the past 10 years, and sustained attainment of CVRF targets as outlined by the European Society of Cardiology (ESC) guidelines [2]. Additionally, Cox regression analysis was conducted to explore potential determinants of new documented cardiovascular events in patients with SLE, adjusting for both traditional CVRFs and disease related factors.

Results: Patients with SLE exhibited a 2.7-fold higher risk of atherosclerotic plaque progression compared to healthy controls (OR: 2.73, CI: 1.19 - 6.23, p=0.017), after adjusting for traditional CVRFs. Within the SLE cohort, multivariate logistic regression analysis revealed a 60% reduction in plaque progression (OR: 0.40, CI: 0.23 - 0.70, p=0.001) for every CVRF consistently meeting the designated target during the 10-year follow-up, including smoking status, blood pressure, lipids, body weight, physical activity. Additionally, in the above analysis adjusting for age, disease duration, sustained CVRF target attainment and cumulative cortisone exposure during follow-up and use of hydroxychloroquine and antiplatelets, we indicated that patients achieving DORIS remission for at least 75% of the follow-up period experienced a 75% decrease in atherosclerosis progression (OR: 0.27, CI: 0.09 - 0.86, p=0.026). Over the 10-year follow-up, 8 new cardiovascular events were documented in the SLE group versus 1 in the healthy control group (p= 0.025). Multivariate Cox regression, adjusting for sustained CVRF target attainment identified APS (OR: 5.76) and persistent triple positivity (OR: 5.76) as independent predictors of 10-year follow-up cardiovascular events.

Conclusion: Patients with SLE manifest an accelerated progression of atherosclerosis, which can be markedly reduced by sustained CVRF control and maintaining prolonged clinical remission. Antiphospholipid syndrome and persistent triple positivity emerged as independent determinants of cardiovascular events in SLE.

REFERENCES: [1] Drosos GC et al. EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome. Ann Rheum Dis. 2022;81:768–79.

[2] Piepoli MF et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2016;37:2315–81.

Acknowledgements: NIL.

Disclosure of Interests: None declared.