Abstract
BackgroundSystemic lupus erythematosus (SLE) is an independent risk factor for cardiovascular events. The present study determined the prevalence of subclinical atherosclerosis in childhood-onset SLE using the carotid intima-media thickness (CIMT) measurement and investigated associations between traditional and nontraditional risk factors for atherosclerosis, such as medications, SLE Disease Activity Index - SLEDAI-2 K and SLICC-ACR damage index and CIMT.MethodsCross-sectional prospective study between 2017 and 2018. CIMT was assessed by ultrasonography. Data were collected by chart review, nutritional evaluation and laboratory tests and analyzed by Fisher, Wilcoxon-Mann-Whitney tests, multiple linear and log binomial regression.ResultsTwenty-eight patients (mean age 13.9 years, SD 3) were enrolled. The prevalence of subclinical atherosclerosis was 32% (95% CI 14.8, 49.4). The mean CIMT was 0.43 ± 0.035 mm. The most common traditional risk factors observed were dyslipidemia (82.1%), uncontrolled hypertension (14.2%), obesity (14.3%), and poor diet (78.6%). Uncontrolled hypertension (p = 0.04), proteinuria (p = 0.02), estimated glomerular filtration rate < 75 ml /min/1.73 m2 (p = 0.02) and SLEDAI-2 K > 5 (P = 0.04) were associated with subclinical atherosclerosis. SLEDAI-2 K > 5 maintained association with CIMT after adjusting for control variables.ConclusionSubclinical atherosclerosis is frequently observed in cSLE, mainly in patients with moderate to severe disease activity.
Highlights
Systemic lupus erythematosus (SLE) is an independent risk factor for cardiovascular events
Childhood-onset systemic lupus erythematosus is more aggressive and carries higher chances of early sequelae when compared to adult-onset SLE [5]
Considering that Carotid intima-media thickness (CIMT), a biomarker for subclinical atherosclerosis, may be associated with traditional and nontraditional risk factors for atherosclerosis, the aims of the study were i) to determine the prevalence of subclinical atherosclerosis assessed by CIMT in patients with Childhood-onset systemic lupus erythematosus (cSLE); ii) to investigate associations between CIMT and traditional and nontraditional risk factors for atherosclerosis
Summary
Systemic lupus erythematosus (SLE) is an independent risk factor for cardiovascular events. Diagnosis and treatment advances have increased the survival of systemic lupus erythematosus (SLE) patients over the last decades. The presence or increase of traditional Framingham risk factors for CVD is insufficient to explain the high CVD index in SLE patients [2]. Childhood-onset systemic lupus erythematosus (cSLE) is more aggressive and carries higher chances of early sequelae when compared to adult-onset SLE [5]. Early detection and prevention of traditional (like hypertension, diabetes, smoking, contraceptives use, higher body mass index and waist circumference, and dyslipidemia) and nontraditional risk factors (like longer SLE duration, increased creatinine clearance, active disease and corticosteroids use) for atherosclerosis in cSLE are of utmost importance for hampering development of CVD in these patients [6]
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