Study: Reducing Cardiovascular Risks Helps Lupus Patients

Patients with systemic lupus erythematosus (SLE) have a 2.3-fold higher risk of atherosclerotic plaque progression over 10 years than healthy people, but controlling traditional cardiovascular disease (CVD) risk factors and achieving long-term remission can reduce that risk, a recent paper reports.¹

Testing positive for three antiphospholipid antibodies (APLs) is associated with increased incidence of CVD events over 10 years, according to researchers from the National and Kapodistrian University of Athens (NKUA), Greece. APLs can mistakenly target the body’s own phospholipids and proteins bound to them and make blood clots more likely.

“Cardiovascular disease in lupus is driven by the cumulative burden of both disease-related and traditional cardiovascular risk factors,” notes senior author Maria Tektonidou, MD, PhD, professor of medicine and head of the Rheumatology Unit at NKUA. Disease-related risk factors include disease activity, disease duration, lupus nephritis, glucocorticoid use and the presence of antiphospholipid antibodies. Traditional risk factors include hypertension, smoking, hyperlipidemia, diabetes, obesity and sedentary lifestyles.

For patients with SLE, “it’s not enough to assess the presence of cardiovascular risk factors. We must persistently control them,” she emphasizes.

The Study

Dr. Maria Tektonidou

Dr. Tektonidou notes that when she and her co-authors began their study in 2012, it was well known that patients with lupus have greater cardiovascular risk than healthy people, but no one had studied the presence and progression of subclinical atherosclerotic plaque in patients over a long period of time. The researchers aimed not only to examine the presence of traditional CVD risk factors, such as hypertension, dyslipidemia and smoking, but also how controlling them consistently over 10 years affects the progression of atherosclerosis and incident cardiovascular events.

The researchers assessed the pro­gres­sion of atherosclerotic plaque in lupus patients over a 10-year period. They also examined the sustained achievement of treat-to-target states in SLE, including lupus low disease activity state and remission according to the Definition of Remission in SLE (DORIS), plus the persistent positivity of APLs throughout the 10-year follow-up period rather than in single point-of-time assessments, says Dr. Tektonidou.

Overall, the researchers analyzed a total of 738 carotid ultrasound measurements from 413 lupus patients and 325 age- and sex-matched controls.

All participants were white, and over 90% were women. Their median blood pressure at baseline was 116/71 mmHg among patients and 120/76 mmHg for controls. About 40% of patients and 33% of controls were current smokers. Slightly more patients had a family history of coronary artery disease (roughly 14% of patients vs. 11.7% of controls). At baseline, median low-density lipoprotein (LDL) cholesterol values measured 107.5 mg/dL for patients and 121 mg/dL for controls. Median body mass index was 24.6 for patients and 24.2 for controls.