[Subclinical and clinical manifestations of atherosclerosis in antiphospholipid syndrome].

AIM

To evaluate intima-media complex (IMC) thickness in patients with antiphospholipid syndrome in terms of clinical-laboratory manifestations and thrombosis risk factors.

MATERIAL AND METHODS

The trial included 206 patients (57 males and 149 females, age 16-59, mean age 35.9 years). Of them, 58 (28%) patients had primary antiphospholipid syndrome (PAPS) alone, 148 had documented concomitant systemic lupus erythematosus (SLE). Seventy two (48.6%) SLE patients had antiphospholipid syndrome (APS), 29 (19.6%)--anticardiolipin antibodies (aCL) level above 40 IU in two and more measurements without clinical symptoms of APS. In addition to standard tests, APL (lupus anticoagulant), aCL and antibodies to beta-2 glycoprotein, blood lipids were measured. Thrombosis and atherothrombosis risk factors were evaluated. Ultrasound dopplerography estimated thickness of IMC in the carotid and femoral arteries. The control group consisted of 89 donors free of autoimmune diseases.

RESULTS

Mean values of IMC thickness did not differ between the groups. Atherosclerotic plaques (ASP) were detected in 25 (12%) of 206 patients: in 5 (9%) from PAPS group, 10 (14%) from SLE+APS, in 4 (14%) and 6 (13%) from SLE groups aPL+ and aPL-, respectively. Mean age of patients with ASP was 46 +/- 6.9 years (32-55 years). ASP occurrence was associated with older age: ASP were detected in 10 (38%) of 26 patients aged over 51 years (24 plaques), in 10 (20%) of 50 patients aged 41-50 years (18 plaques) and in 5 (10%) of 50 patients aged 41-50 years (18 plaques) and in 5 (10%) of 50 patients aged 31-40 years (9 plaques, p = 0.001). IMC thickness and plaques were associated with prior arterial and venous thromboses and occurred significantly more frequently in patients with myocardial infarction and transient ischemic attacks (p < 0.001). Thrombosis and atherothrombosis risk factors were associated with changed IMC thickness. The level of aPL and their type had no effect on IMC thickness and ASP incidence in the groups studied.

CONCLUSION

Increased IMC thickness was associated with age irrespective of APS presence. In SLE, ASP appeared at younger age than in PAPS patients. Atherothrombosis risk factors affect IMC thickness irrespective of the level and type of aPL.