Relation of Carotid Intima-Media Thickness and Plaque With Incident Cardiovascular Events in Women With Systemic Lupus Erythematosus

Kao, Amy H.; Lertratanakul, Apinya; Elliott, J; Sattar, Abdus; Santelices, Linda; Shaw, Penny; Birru, Mehret; Avram, Z.; Thompson, Trina; Sutton-Tyrrell, Kim; Ramsey‐Goldman, Rosalind; Manzi, Susan

doi:10.1016/j.amjcard.2013.05.040

Cited by 85 publications

(97 citation statements)

References 28 publications

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“…There are also significant data in other diseases that share pathophysiological overlap with HIV. Specifically, the mechanisms of increased vascular risk in HIV are likely related to immune activation and an increase in inflammation 24, 25 and in other diseases where an immune activation and inflammation play a key pathophysiological role, an increase in incidental carotid plaque has been reported 26, 27 . For example, in rheumatoid arthritis and diabetes, data have described an increase in incidental carotid plaque 28, 29 .…”

Section: Discussionmentioning

confidence: 99%

Presence, Characteristics, and Prognostic Associations of Carotid Plaque Among People Living With HIV

Janjua

Staziaki

Szilveszter

et al. 2017

Circ: Cardiovascular Imaging

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Background Data from broad populations has established associations between incidental carotid plaque and vascular events. Among persons living with HIV (PLWHIV), the risk of vascular events is increased; however, whether incidental carotid plaque is increased and there is an association between incidental carotid plaque, plaque characteristics and vascular events among PLWHIV is unclear. Methods and Results Data from the multi-institutional Research Patient Data Registry was used. Presence and characteristics (high-risk plaque (HRP) including spotty calcification and low attenuation) of carotid plaque by CT among PLWHIV without known vascular disease were described. Data were compared to uninfected controls similar in age, sex and cardiovascular risk factors including DM, HLD and cigarette smoking to cases. Primary outcome was an ASCVD event and secondary outcome was ischemic stroke. Cohort consisted of 209 PLWHIV (45±10 years, 72% male) and 168 controls. Using CT, PLWHIV without vascular disease had a higher rates of any carotid plaque (34 vs. 25%, p=0.04), non-calcified (18 vs. 5%, p<0.001) and HRP (25 vs. 16%, p=0.03). Over a follow-up of 3 years, 19 ASCVD events (9 strokes) occurred. Carotid plaque was independently associated with a 3-fold increase in ASCVD events among PLWHIV (HR: 2.91, CI: 1.10–7.7, p=0.03) and a 4-fold increased risk of stroke (HR: 4.43, CI: 1.17–16.70, p=0.02); HRP was associated with a 3-fold increased risk of ASCVD events and a 4-fold increased risk of stroke. Conclusion There is an increase in incidental carotid plaque, non-calcified plaque and HRP among PLWHIV and the presence and characteristics of carotid plaque are associated with subsequent vascular events.

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Section: Discussionmentioning

confidence: 99%

Presence, Characteristics, and Prognostic Associations of Carotid Plaque Among People Living With HIV

Janjua

Staziaki

Szilveszter

et al. 2017

Circ: Cardiovascular Imaging

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“…In large studies without comparison with healthy controls, Manzi and colleagues ( n = 175) [41] and Kao and colleagues ( n = 392) [20] have observed carotid plaques in 30 to 40% of SLE patients.…”

Section: Discussionmentioning

confidence: 99%

Atherosclerotic plaques occur in absence of intima-media thickening in both systemic sclerosis and systemic lupus erythematosus: a duplexsonography study of carotid and femoral arteries and follow-up for cardiovascular events

et al. 2014

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IntroductionThe objective of this cross-sectional and retrospective cohort study was (1) to determine the usefulness of intima-media thickness (IMT) in contrast to plaque assessment, (2) to examine the value of additive femoral artery sonography and (3) to identify potential risk factors for atherosclerosis and incident cardiovascular events in systemic sclerosis (SSc) and systemic lupus erythematosus (SLE) patients.MethodsIn this study, 90 SSc and 100 SLE patients were examined by duplexsonography. IMT was measured in common carotid and common femoral arteries, plaques were assessed in common, internal and external carotid and common, proximal superficial and deep femoral arteries. Different definitions of pathological IMT (pIMT) were compared with the presence of plaque. Results were evaluated in relation to traditional and non-traditional risk factors for baseline atherosclerosis (logistic regression) and their predictive value for cardiovascular events during follow-up (cox regression).ResultsDefinite atherosclerosis occurred frequently without signs of subclinical atherosclerosis in both diseases: pIMT >0.9 mm was present in only 17/59 (28.9%) SSc and 13/49 (26.5%) SLE patients with already present atherosclerotic plaques. Using age-adjusted pIMT definitions, this rate was even lower (5.1-10.3% in SSc, 14.3-26.5% in SLE). Plaques were located only at the carotid or only at the femoral arteries in 26 (13.7%) and 24 (12.6%) patients, respectively. Age and nicotine pack-years were independently associated with atherosclerotic plaques in SLE and SSc patients, as well as the cumulative prednisolone dose in SSc subgroup, and ssDNA positive SLE patients had a lower risk for atherosclerotic plaque. During follow-up (available for 129/190 (67.9%) patients, 650 person-years), cardiovascular events occurred more often in patients with coronary heart disease (adjusted-hazards ratio (HR) 10.19, 95% confidence interval (CI) 3.04 to 34.17, P <0.001), male patients (adjusted-HR 8.78, 95% CI 2.73 to 28.19, P <0.001) and in patients with coexistent carotid and femoral plaques (adjusted-HR 5.92, 95% CI 1.55 to 22.67, P = 0.009). Patients with solely carotid or femoral plaque were not at higher risk.ConclusionAtherosclerotic plaque lesions can be found frequently in absence of intima-media thickening in both SSc and SLE patients. As well as routine sonography of carotid arteries, the sonography of femoral arteries is recommended to identify additional atherosclerotic lesions and to detect patients at a high risk for cardiovascular events.

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“…In addition, these risk factors significantly contribute to intima-media thickness and plaque progression, which are reproducible markers of subclinical ATS and useful tools for prediction of CV events, as recently demonstrated in patients with systemic autoimmune diseases [2][3][4]. In this setting, it is now clear that chronic inflammatory/autoimmune rheumatic diseases are characterized by an acceleration Original Article of ATS.…”

Section: Introductionmentioning

confidence: 90%

Cardiovascular disease risk burden in primary Sjögren's syndrome: results of a population‐based multicentre cohort study

et al. 2015

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Abstract. Bartoloni E, Baldini C, Schillaci G, Quartuccio L, Priori R, Carubbi F, Bini V, Alunno A, Bombardieri S, De Vita S, Valesini G, Giacomelli R, Gerli R (University of Perugia, Perugia; University of Pisa, Pisa; Terni University Hospital, Terni; University of Udine, Udine; Sapienza University of Rome, Rome; University of L'Aquila, L'Aquila; and University of Perugia, Perugia; Italy). Cardiovascular disease risk burden in primary Sj€ ogren's syndrome: results of a population-based multicentre cohort study. J Intern Med 2015; 278: 185-192.Objective. Systemic autoimmune diseases, in particular systemic lupus erythematosus and rheumatoid arthritis, are characterized by a high risk of premature cardiovascular (CV) events. Diseaserelated characteristics and traditional CV disease risk factors may contribute to atherosclerotic damage. However, there are limited data on the risk of overt CV events in primary Sj€ ogren's syndrome (pSS).Methods. We retrospectively analysed a cohort of patients with 1343 pSS. Disease-related clinical and laboratory data, traditional CV disease risk factors and overt CV events were recorded. Prevalence of traditional CV disease risk factors and of major CV events was compared between a subgroup of 788 female patients with pSS aged from 35 to 74 years and 4774 age-matched healthy women.Results. Hypertension and hypercholesterolaemia were more prevalent, whereas smoking, obesity and diabetes mellitus were less prevalent, in women with pSS than in control subjects. Cerebrovascular events (2.5% vs. 1.4%, P = 0.005) and myocardial infarction (MI) (1.0% vs. 0.4%, P = 0.002) were more common in patients with pSS. In the whole population, central nervous system involvement (odds ratio (OR) 5.6, 95% confidence interval (CI) 1.35-23.7, P = 0.02) and use of immunosuppressive therapy (OR 1.9, 95% CI 1.04-3.70, P = 0.04) were associated with a higher risk of CV events. Patients with leucopenia had a higher risk of angina (P = 0.01).Conclusions. pSS is associated with an increased risk of cerebrovascular events and MI. Disease-related clinical and immunological markers may have a role in promoting CV events.

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Relation of Carotid Intima-Media Thickness and Plaque With Incident Cardiovascular Events in Women With Systemic Lupus Erythematosus

Cited by 85 publications

References 28 publications

Presence, Characteristics, and Prognostic Associations of Carotid Plaque Among People Living With HIV

Presence, Characteristics, and Prognostic Associations of Carotid Plaque Among People Living With HIV

Atherosclerotic plaques occur in absence of intima-media thickening in both systemic sclerosis and systemic lupus erythematosus: a duplexsonography study of carotid and femoral arteries and follow-up for cardiovascular events

Cardiovascular disease risk burden in primary Sjögren's syndrome: results of a population‐based multicentre cohort study

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