Multivariate regression models examined potential predictors of plaque progression, including patient characteristics, systemic coronary risk evaluation and attaining traditional CVD risk factor targets. These traditional CVD targets included blood pressure below 140/90 mmHg, BMI of 25 or less, not smoking, healthy levels of blood lipids and physical activity. In addition to DORIS, other predictors studied included medications and persistent triple APL positivity during follow-up. The researchers recorded cardiovascular events over 10 years and assessed potential associations.
Findings
Lupus patients’ plaque progression was lowered by 32% with each sustainably achieved traditional cardiovascular risk-factor target. Achieving DORIS-defined remission for 75% or more of the follow-up period was associated with a 43% decrease in atherosclerosis progression risk.
Triple APL positivity—which includes lupus anti-coagulant, anti-cardiolipin and anti-beta2 glycoprotein I antibodies—increased the risk for incident cardiovascular events over the 10-year follow-up period, Dr. Tektonidou notes. This finding shows the need for early identification of APLs and managing them appropriately, the paper states.
“Among disease-related features, persistent antiphospholipid antibody positivity, particularly triple positivity, emerged as an important risk predictor for incident CVD events in our SLE cohort, recognizing a subgroup of patients at even higher risk,” she adds.
Dr. Tektonidou was surprised that seven of eight lupus patients who developed cardiovascular events during the 10-year follow-up were considered at low or moderate risk for cardiovascular disease by commonly used prediction tools. “This finding suggests carotid atherosclerotic plaque presence can improve cardiovascular risk stratification,” she says.
Dr. Tektonidou was also surprised that cumulative glucocorticoid dose, a well-established predictor of CVD events, was not correlated with plaque progression or incident CVD events. This finding may result from low disease activity and subsequently low glucocorticoid doses (a median of 0.3 mg) administered daily during follow-up, she says.
Although long-term hydroxychloroquine use has been previously associated with reduced CVD risk in individuals with SLE, “our results could not show that consistent hydroxychloroquine use throughout the 10-year follow-up protected against atherosclerosis progression or incident CVD events,” Dr. Tektonidou says. “A possible explanation is that most of our patients used hydroxychloroquine consistently throughout follow-up.”
The small number of incident CVD events in the cohort limited the statistical power for multivariate analysis and robust associations with incident CVD events, Dr. Tektonidou says.
She plans to confirm her findings in larger, more diverse groups of SLE patients. In the meantime, Dr. Tektonidou encourages other research teams “to use longitudinal and trajectory-based analysis instead of relying on cross-sectional evaluations when assessing CVD risk in autoimmune diseases, including SLE.” Additionally, Dr. Tektonidou points to a need for reliable biomarkers to accompany clinical and imaging parameters to enhance CVD risk stratification and refine existing risk prediction tools.
