Assessment of Atherosclerosis in Sle Patients by Measuring Carotid Intima Media Thickness: A Cross Sectional Study.

UNLABELLED

SLE patients have an increased burden of atherosclerosis leading to adverse cardiovascular events.Alterations in endothelial function, dysregulated immune system and increased oxidative stress are implicated in their development and progression. Carotid Artery Ultrasound has been recommended by the AHA/ACC to assess and follow progression of subclinical atherosclerosis & correlate with traditional /non traditional CV risk factors in SLE. To study the correlation between Carotid Intima Media Thickness, traditional/non traditional CV risk factors in SLE.

MATERIAL

Hospital based descriptive, cross sectional study.Patients with Systemic Lupus Erythematosus, diagnosed by SLICC 2012 criteria, aged > 12 years, irrespective of therapy status, between April 2019 to August 2020, were recruited by consecutive sampling. Non consenting patients, individuals with preexisting cardiovascular disease, history of MACE, hypothyroidism (detected prior to diagnosis of SLE/disease onset), smokers, PLHIV,individuals with neck surgical, radiation, were excluded.

OBSERVATION

55 SLE patients were observed. No individuals were lost to follow up. Subgroup analysis was performed between SLE with Nephritis (36) and those without Nephritis (19) as presenting features. The mean age of the study subjects is 33 years with mean disease duration of 4.6 years.SLE nephritis patients had longer disease duration,younger age of disease onset & longer duration of steroid usage.The mean Systolic BP is 134+/-20mmHg, observed to be significantly higher in SLE nephritis patients. Framingham Risk scores were positively correlated with duration of SLE disease & SLEDAI 2K scores & duration of steroid therapy. The mean CIMT of the study population is 0.91mm with 10.9% plaque prevalence whereas Mean CIMT of Lupus nephritis patients is 1.02+/- 0.27mm; but no statistically significant difference in CIMT was observed between two subgroups. Carotid Intima Media thickness was positively correlated in bivariate analysis with anti DSDNA ab levels, Framingham Risk Scores,anaemia, SLE Disease activity scores, 24hr urine proteinuria,duration of steroid usage, Serum Creatinine & CRP. No correlation between CIMT and age of subjects,FPG,TG,serum homocysteine was observed.

CONCLUSION

SLE patients have a high atherosclerosis burden and are at increased risk of adverse cardiovascular events. Carotid intima media thickness measurement by USG doppler is a reliable, non invasive, inexpensive tool which helps to detect subclinical atherosclerosis and plaques in SLE patients. In this study,Lupus Nephritis patients, Neuropsychiatric SLE and SLE with secondary APS, early age of lupus onset, longer disease duration with prolonged steroid therapy,significant proteinuria, higher antiDSDNA ab levels and hypocomplementemia are observed to have higher mean CIMT and plaque formation.