Controlling cardiovascular risk factors reduces progression of atherosclerosis in a multiethnic cohort of patients with lupus

Objective Patients with SLE have increased risk of both clinical cardiovascular disease (CVD) and subclinical atherosclerosis. Reports have shown that controlling CVD risk factors reduces subclinical plaque progression in patients with SLE. We investigated whether this finding was confirmed in our ethnically diverse cohort of patients, measuring total plaque area (TPA) as well as the number of plaques.Methods 69 patients with SLE underwent ultrasound scans of the carotid and common femoral arterial bifurcations on two occasions (mean 63 months apart). Clinical, demographic, CVD risk and treatment factors were recorded for each patient. Change in plaque number and increase in TPA between scans were the outcome measures.Results 31 patients had plaque at the second scan. 13 had unchanged number of plaques while 18 had increased plaque numbers including six who were initially free of plaque. All 31 patients had increased TPA with median increase 4.59 mm2/year (IQR 2.4–7.33) and these patients were subdivided into two groups with change in TPA above or below the median. Factors associated with both increased plaque number and above-median TPA increase at the second scan compared with the first were age at baseline, positive lupus anticoagulant, negative anti-La and failure to attain at least three CVD risk targets within the follow-up period between scans. We found no associations with disease activity or medication.Conclusion In this ethnically diverse (40% non-Caucasian) population, we confirmed earlier findings that better control of CVD risk targets reduces progression of atherosclerotic plaque. Anti-La positivity was associated with less plaque progression, which was unexpected.