Semiquantified Noncalcified Coronary Plaque in Systemic Lupus Erythematosus

Abstract

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.

Atherosclerosis in Systemic Lupus Erythematosus

“…119 The homocysteine levels did not differ compared with the patients who were not on methotrexate. This was a surprising finding due to the well-documented reduced risk of cardiovascular events in patients with rheumatoid arthritis who were treated with methotrexate.…”

Atherosclerosis in Systemic Lupus Erythematosus – Epidemiology, Risk Factors, Subclinical Assessment and Future Study

“…CAC alone is not reflective of the absolute burden of atherosclerosis and studies from the general population suggest non-calcified coronary plaque (NCP) may be more important [35,36]. In SLE, multi-detector CT technology has shown that 53% (N=52/99) of patients without CAC have evidence of NCP, compared to 96% of patients with CAC [37]. Studies from the general population, however, suggest a much lower prevalence of NCP, where 6.5 to 16% have NCP in the absence of CAC [38,39], again demonstrating the greater burden of atherosclerosis in SLE.…”

Progression of noncalcified and calcified coronary plaque by CT angiography in SLE

“…In a cross-sectional study among patients in the Hopkins lupus cohort, one hundred and forty-seven patients underwent semiquantified assessment of noncalcified coronary plaque by 64-slice multi-detector computed tomography [24]. This included the baseline samples of the patients reported here.…”

“…Patient age (P= 0.0001), current methotrexate use (P= 0.0005), history of anti-dsDNA positivity (P = 0.019) and obesity (assessed by body mass index, P= 0.058) were associated with the presence of noncalcified coronary plaque, in the multivariate model. Use of hydroxychloroquine and prednisone had no effect on the quantification of noncalcified coronary plaque [24]. …”

“…Furthermore, plaque characteristics, including remodeling, were noted for each segment. These metrics were integrated for a total plaque severity score as previously described [24]. Briefly, the NCP score was the sum of plaque severity multiplied by plaque composition, divided by the number of vessels examined.…”