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Duplex Study of the Carotid and Femoral Arteries of Patients with Systemic Lupus Erythematosus:
A Controlled Study
TALIA WOLAK, EVGUENIA TODOSOUI, GABRIEL SZENDRO, ARKADI BOLOTIN, BAT-SHEVA JONATHAN, DANIEL FLUSSER, DAN BUSKILA, SHAUL SUKENIK, and MAHMOUD ABU-SHAKRA
ABSTRACT. Methods. Fifty-one consecutive patients with SLE were enrolled in the study. Controls were matched by age, sex, ethnicity, and atherosclerosis risk factors. All patients and controls underwent ultrasonic biopsy (U-B) of the CFA and CCA, a noninvasive screening technique that detects early atherosclerotic plaques and changes. The U-B features were classified and scored as follows: class A: normal (score 0); class B: interface disruption (score 2); class C: intima-media granulation (score 4); class D: plaque without hemodynamic disturbance (score 6); class E: stenotic plaque (score 8); and class F: plaque with symptoms (score 10). Total score was calculated. Classes A and B indicate an intact media; classes D to F point to a significant medial involvement; class C signifies a borderline lesion with a potential for regression to normal or progression to a plaque. Results. Mean ages were 40.5 years for SLE patients and 41 years for controls (p = 0.6). Ninety-six percent of the patients and controls were women. The mean disease duration of SLE was 8.65 years. Frequencies of risk factors among the SLE patients compared to controls were hypertension (30% vs 24%), smoking (23% vs 24%), and dyslipidemia (17.7% vs 17%). No patient had diabetes mellitus or family history of cardiovascular disease. A 3.17-fold increased rate of atherosclerotic plaques was detected in the SLE patients compared with controls (95% CI 1.08–10.9). Twenty-eight percent of SLE patients had at least a single class D–F lesion in one of the 4 vessels tested, compared with 10% in the control group (p = 0.02). In addition, the mean total U-B score of the SLE patients was significantly higher than that of the controls (5.65 vs 3.14; p = 0.02). Univariate analyses showed that the development of plaques in SLE was associated with a history of ischemic heart disease, hypertension, cardiovascular accident, and anemia. Multivariate analysis found plaques to be strongly associated with age, particularly in those older than 50 (OR 2.66, p = 0.000). Conclusion. Patients with SLE have a high rate of atherosclerotic changes compared to controls. The development of atherosclerosis is strongly associated with age. (J Rheumatol 2004;31:909-14) Key Indexing Terms:
SYSTEMIC LUPUS ERYTHEMATOSUS
From the Rheumatic Diseases Unit, Department of Medicine D, the Vascular Laboratory, and the Epidemiology Unit, Soroka University Medical Center and The Faculty of Health Sciences, Ben Gurion University, Beer-Sheva, Israel. T. Wolak, MD, Instructor in Medicine; E. Todosoui, MD, Instructor in Medicine, Department of Medicine; G. Szendro, MD, Associate Professor of Surgery, Head, Department of Vascular Surgery and Vascular Laboratory; A. Bolotin, PhD, Epidemiology Unit; B-S. Jonathan, Registered Vascular Technologist, Vascular Laboratory; D. Flusser, MD, Lecturer, Rheumatic Disease Unit, Department of Medicine; D. Buskila, MD, Professor in Medicine, Head, Rheumatic Diseases Unit; S. Sukenik, MD, Professor in Medicine, Rheumatic Disease Unit, Head, Department of Medicine; M. Abu-Shakra, MD, Associate Professor in Medicine, Rheumatic Disease Unit. Address reprint requests to Prof. M. Abu-Shakra, Department of Medicine D, Soroka University Medical Center, PO Box 151, Beer-Sheva, Israel. E-mail: mahmoud@bgumail.bgu.ac.il Submitted January 8, 2003; revision accepted November 21, 2003. |