Subclinical atherosclerosis is associated with future cardiovascular events in lupus patients at apparent low cardiovascular risk

Objectives Prediction models based on traditional risk factors underestimate the risk for cardiovascular events (CVE) in SLE. We aimed to assess the occurrence of CVE in SLE patients according to their baseline subclinical atherosclerosis status. Methods Carotid intima-media thickness at the carotid bulb level (CIMT) was prospectively assessed in consecutive SLE patients followed in our national reference center for rare diseases by a single evaluator, between February 2012 and February 2013. SLE patients with known CVE were excluded. CIMT >1.5 mm defined carotid plaque as a measure of subclinical atherosclerosis. The main outcome was a CVE defined as the occurrence during follow-up of myocardial infarction, ischemic stroke or symptomatic peripheral arterial disease. Results 63 SLE patients (82.5% female, median age 39 [32–44.5]) were included. Among them, 24 (38.1%) had a carotid plaque >1.5 mm at baseline and 7 (11.1%) experienced a cardiovascular event during a median follow-up of 10.7 [8.2–11.0] years. All CVE occurred in the group of patients who had a carotid plaque at baseline. In the multivariable analysis, we observed that, after adjusting for the Framingham score and the body mass index, the presence of a carotid plaque was significantly associated with the occurrence of a cardiovascular event: odds ratio [95% confidence interval] = 17.2 ; 95 CI: [1.15–2499]; p = 0.039). Conclusion Subclinical atherosclerosis defined as a carotid plaque >1.5 mm is significantly associated with the clinical cardiovascular risk in SLE. Subclinical atherosclerosis should be regularly assessed in this population as part of the global cardiovascular risk evaluation.