[Risk factors of thickened intima-media and atherosclerotic plaque development in carotid arteries in patients with systemic lupus erythematosus].

INTRODUCTION: The aim of the study was: (1) The evaluation of the frequency of intima-media thickening (IMT) and the presence of atherosclerotic plaques in carotid arteries in patients with systemic lupus erythematosus (SLE) in comparison with the control group. (2) The evaluation of the correlation between IMT and the presence of atherosclerotic plaques in carotid arteries in patients with SLE and the association of selected immunological and genetic parameters, markers of inflammation, traditional risk factors of atherosclerosis and its treatment. (3) The evaluation of practical usefulness of IMT measurement in diagnostics of early atherosclerosis and the evaluation of risk of its complications in patients with SLE. (4) The evaluation of the correlation between IMT and the presence of atherosclerotic plaques in carotid arteries and selected systemic complications in patients with SLE.

MATERIAL AND METHODS: In a group of 103 SLE patients and 30 healthy people (control group) was performed B-mode ultrasound examination of carotid arteries, using HDI 3500 (ATL) with linear transducer 5-12 MHz to evaluate the presence of atherosclerotic changes. There were evaluated traditional risk factors of atherosclerosis, selected autoantibodies and markers of inflammatory reaction, selected genes polymorphism and applied treatment. Statistical analysis was performed with chi2 Yates, chi2 Pearson and R rank Spearman tests. Multivariate regression analysis was also done.

RESULTS: Thickened IMT and carotid plaques are significantly more frequent in SLE patients in comparison with the control group (p = 0.0002 and p = 0.0035 respectively). Among traditional risk factors of atherosclerosis hypertension, male gender and age above 45 years were significantly associated with the presence of atherosclerotic changes. The main autoantibodies, which were significantly associated with the risk of the presence of atherosclerotic disorders were as follows: antiprothrombin antibodies (aPTR) in IgA class (OR = 5.5; 95% CI: 1.1-30.2), anti-neutrophil cytoplasmic antibodies (ANCA) directed against elastase (OR = 14.7; 95% CI: 1.4-38.0) and cathepsin G (OR = 10.8; 95% CI: 1.1-126.3) and anti-endothelial cell antibodies (AECA) (OR = 6.6; 95% CI: 1.6-28.3). It was confirmed, that high cumulated dose of glucocorticosteroids is significantly associated with increased risk of development of atherosclerotic changes (OR = 2.4; 95% CI: 1.1-5.5).

CONCLUSIONS: (1) The thickening of intima-media and the presence of carotid plaques are significantly more frequent in patients with SLE in comparison with the control group. (2) Systemic lupus erythematosus and antiphospholipid syndrome are risk factors for thickening of intima-media and carotid plaques development. (3) The risk factors of thickening intima-media and carotid plaques development in patients with SLE are selected autoantibodies, inflammatory process and applied treatment. (4) Traditional risk factors of atherosclerosis are not the leading cause of thickened intimamedia and carotid plaques development in patients with SLE contrary to the general population. (5) Measurement of intima-media thickness might be useful in the evaluation of early atherosclerosis and risk of its complications in patients with SLE in routine diagnostics. (6) Thickening of intima-media and the presence of carotid plaques in patients with SLE are associated with significant risk of severe systemic complications, mainly related to cardiovascular and central nervous system.