Cardiovascular disease (CVD) is a leading cause of death in individuals with systemic lupus erythematosus (SLE). Additionally, subclinical atherosclerosis, which is an independent predictor of CVD events, is more prevalent in patients with SLE than other high CVD risk disorders and progresses more rapidly in patients with SLE than in the general population.
In a study, Papazoglou et al. assessed the progression of atherosclerosis and the development of cardiovascular events in patients with SLE compared with healthy controls over a 10-year, follow-up period.
Methods
The researchers prospectively analyzed 738 carotid ultrasound measurements from 413 patients with SLE and 325 healthy controls who were matched for age and sex. They used this baseline data to assess and compare new plaque development of patients at three, seven and 10 years of follow-up.
Multivariate mixed-effects Poisson regression models examined potential predictors of plaque progression, including patient characteristics, disease-related and traditional cardiovascular risk factors, and the attainment of traditional cardiovascular risk factor targets. During follow up, researchers also assessed Systemic Coronary Risk Evaluation, Definition of Remission in SLE (DORIS), different durations of Lupus Low Disease Activity State (LLDAS), medications and persistent triple anti-phospholipid antibody (aPL) positivity.
Ten-year incident cardiovascular events were recorded, and univariate Cox regression analysis assessed potential associations.
The Results
In the study, patients with SLE experienced a 2.3-fold higher risk of carotid plaque progression over 10 years than healthy controls (incidence rate ratio [IRR] 2.26, P=0.002). This risk was mitigated by the sustained attainment of cardiovascular risk factor targets during follow-up, including blood pressure, lipids, smoking, body weight and physical activity. Plaque progression risk in patients with SLE was reduced by 32% (IRR 0.68, P=0.004) per each target risk factor sustained.
Prolonged clinical remission also mitigated the 10-year risk of atherosclerosis progression in patients with SLE. In the study, maintaining DORIS for at least 75% of follow-up was associated with a 43% reduction in plaque progression risk (IRR: 0.57; P=0.033). However, the study’s multivariate analysis showed that none of the durations of LLDAS examined prevented plaque progression. The authors note that these findings “support the importance of prioritizing a sustained remission rather than a low disease activity state for the prevention of atherosclerosis development and progression in patients with SLE.”
Additionally, researchers observed a significantly higher incidence of CVD events in patients with SLE than healthy controls. The 10-year risk of incident CVD events was higher in individuals with SLE than healthy controls: eight vs. one event (permutation-based log-rank P=0.036). Persistent triple aPL positivity is associated with increased incidence of CVD events.
For complete details, including source material, refer to the full study.
Excerpted and adapted from:
Papazoglou N, Sfikakis PP, Tektonidou MG. Atherosclerotic plaque progression and incident cardiovascular events in a 10-year prospective study of patients with systemic lupus erythematosus: The impact of persistent cardiovascular risk factor target attainment and sustained DORIS remission. Arthritis Rheumatol. 2025 Jun;77(5).
