Abstract
BackgroundCardiovascular disease (CVD) is the main cause of death in systemic lupus erythematous (SLE) patients. The Framingham score underestimates the risk for CVD in this population. Our study aimed to determine whether serum high-sensitivity cardiac troponin T (HS-cTnT) might help to identify SLE patients at risk for CVD.MethodsThe presence of carotid plaques was prospectively assessed by ultrasound in 63 consecutive SLE patients asymptomatic for CVD and 18 controls. Serum HS-cTnT concentration was measured using the electrochemiluminescence method. Factors associated with carotid plaques were identified and multivariate analysis was performed.ResultsFramingham score was low in both SLE patients (median 1 (range 1–18%)) and controls (1 (1–13%)). Nevertheless, 23 (36.5%) SLE patients, but only 2 (11.1%) controls (p = 0.039), had carotid plaque detected by vascular ultrasound. In the multivariate analysis, only age (p = 0.006) and SLE status (p = 0.017) were independently associated with carotid plaques. Serum HS-cTnT concentration was detectable (i.e. >3 ng/L) in 37 (58.7%) SLE patients and 6 (33.3%) controls (p = 0.057). Interestingly, 87% of SLE patients with carotid plaques, but only 42.5% of SLE patients without plaques (p < 0.001), had detectable HS-cTnT. Conversely, 54.5% of SLE patients with detectable HS-cTnT, but only 11.5% with undetectable HS-cTnT (p < 0.001), had a carotid plaque. In the multivariate analysis, only body mass index (p = 0.006) and HS-cTnT (p = 0.033) were statistically associated with carotid plaques in SLE patients. Overall, the risk of having a carotid plaque was increased by 9 (odds ratio 9.26, 95% confidence interval 1.55–90.07) in SLE patients in whom HS-cTnT was detectable in serum.ConclusionSerum HS-cTnT level is high and associated with carotid plaques in SLE patients who are at an apparently low risk for CVD according to the Framingham score. HS-cTnT may be a useful biomarker for SLE-associated atherosclerosis.
Highlights
Cardiovascular disease (CVD) is the main cause of death in systemic lupus erythematous (SLE) patients
The absolute risk of cardiovascular events occurring within the 10 years according to the Framingham score was 1 (1–18)% and 1 (1–13)% in SLE patients and controls, respectively (p = 0.416)
Lupus is an independent risk factor for carotid plaque in patients at apparent low risk for cardiovascular disease While both groups shared a low Framingham risk score, 23 (36.5%) SLE patients but only 2 controls (11.1%) had a carotid atherosclerotic plaque identified by vascular ultrasound (p = 0.039)
Summary
Cardiovascular disease (CVD) is the main cause of death in systemic lupus erythematous (SLE) patients. Our study aimed to determine whether serum high-sensitivity cardiac troponin T (HS-cTnT) might help to identify SLE patients at risk for CVD. Cardiovascular disease (CVD) is recognized as the leading cause of death in systemic lupus erythematosus (SLE) patients [1]. The Framingham risk equation usually underestimates the 10-year cardiovascular risk in the SLE population [6]. Cardiac troponin (cTnT) is a well-known marker of myocyte necrosis and injury in the early phase of acute myocardial infarction [7, 8]. Measured with highsensitivity (HS) assays, HS-cTnT has a proven predictive value for coronary heart disease, heart failure, and mortality in the general population at apparent low-risk for CVD [9]. There are, no data regarding the predictive value of HS-cTnT in the context of SLE
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