Abstract 12493: Comparison of Coronary Plaque Progression by Coronary Computed Tomography Angiography in Systemic Lupus Erythematosus and Rheumatoid Arthritis

Abstract

Introduction: Systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) are autoimmune diseases associated with high incidence of cardiovascular disease (CVD), likely related to common underlying pathways of inflammation. Characterization of coronary atherosclerosis, particularly total plaque (TP) and total non-calcified plaque (TNCP), on Coronary Computed Tomography Angiography (CCTA) has been correlated with adverse CV events. We compared rates of coronary plaque progression by serial CCTA in SLE and RA patients. Methods: Semi-automated plaque software (Qangio, Medis) was used for quantitative coronary assessment. Analysis included 22 SLE [48.5 (13.0) years; 19 females; 64% White] and 22 age and sex- matched RA patients [49.1 (11.2) years; 19 females; 95% Hispanic]. Linear regression was used to compare log adjusted total atheroma volume ((TAV norm ) = (Plaque volume)/Vessel length * mean cohort vessel length)) for TP and TNCP between SLE and RA patients. Results: Baseline mean levels of TAV norm for TP and TNCP in RA patients vs SLE patients were 0 (0 - 7.3) mm 3 vs 21.2 (1.1 - 64.1) mm 3 (p <.0001) and 0 (0 - 5.8) mm 3 vs 19.5 (1.1 - 62.2) mm 3 (p<.0001), respectively. After adjustment for baseline plaque and CV risk factors, progression of TAV norm was higher in SLE than RA patients (log TAV TP volume (β: 2.271 (.530), p=.0001) and log TNCP volume (β: 2.384 (.502), p<.0001) (Table 1). Patients with RA had 87% less TP and 89% less TNCP progression than those with SLE. Conclusions: These results suggest that coronary plaque progression is greater in young, adult SLE patients, compared to RA patients. These results improve the mechanistic understanding of increased CV risk in these patients. Further research to evaluate screening and targeted management strategies for CVD in this high risk cohort, especially SLE is warranted.