Objective-A major cause of morbidity and mortality in systemic lupus erythematosus (SLE) is accelerated coronary atherosclerosis. New technology (computed tomographic angiography) can measure noncalcified coronary plaque (NCP), which is more prone to rupture. We report on a study of semiquantified NCP in SLE.Methods-Patients with SLE (n = 147) with no history of cardiovascular disease underwent 64-slice coronary multidetector computed tomography (MDCT). The MDCT scans were evaluated quantitatively by a radiologist, using dedicated software.Results-The group of 147 patients with SLE was 86% female, 70% white, 29% African American, and 3% other ethnicity. The mean age was 51 years. In our univariate analysis, the major traditional cardiovascular risk factors associated with noncalcified plaque were age (p = 0.007), obesity (p = 0.03; measured as body mass index), homocysteine (p = 0.05), and hypertension (p = 0.04). Anticardiolipin (p = 0.026; but not lupus anticoagulant) and anti-dsDNA (p = 0.03) were associated with higher noncalcified plaque. Prednisone and hydroxychloroquine therapy had no effect, but methotrexate (MTX) use was associated with higher noncalcified plaque (p = 0.0001). In the best multivariate model, age, current MTX use, and history of anti-dsDNA remained significant. Conclusion-Our results suggest that serologic SLE (anti-dsDNA) and traditional cardiovascular risk factors contribute to semiquantified noncalcified plaque in SLE. The association with MTX is not understood, but should be replicated in larger studies and in multiple centers.
Key Indexing Terms
SYSTEMIC LUPUS ERYTHEMATOSUS; CARDIOVASCULAR DISEASE; RISK FACTORS; COMORBIDITYCardiovascular disease, specifically from accelerated premature atherosclerosis, is a major cause of morbidity and mortality in systemic lupus erythematosus (SLE) 1 . Patients with SLE are 2 to 9 times more likely than the general population to have myocardial infarctions 2,3,4 . The pathogenesis is multifactorial, including traditional cardiovascular risk factors, but also corticosteroids and inflammatory pathways 5,6,7,8 . The risk of an acute cardiac event is affected by the presence, extent, location, characteristics, and metabolic activity of coronary atherosclerotic plaque 13,14,15 . Noncalcified plaque may be more metabolically active than highly calcified plaque and preliminary data suggest that the presence of noncalcified or only partially calcified plaques is associated with greater risk of unstable presentation 16 . Motoyama, et al reported that the appearance of low attenuation plaque on multidetector CT was an independent predictor of acute coronary syndrome events for a 2-year followup period 17 . Noncalcified plaque may be present in the absence of coronary artery calcification: in a Japanese study, the prevalence of noncalcified plaque was 11.1% in patients with no coronary artery calcium and 23.4% in patients with mild coronary artery calcium 18 .In our previous study of noncalcified plaque in SLE, we found that 54% of patients with SLE h...