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Disease damage influences cardiovascular risk reclassification based on carotid ultrasound in patients with systemic lupus erythematosus

Abstract: OBJECTIVE: Composite scores of cardiovascular (CV) risk factors underestimate the CV risk in patients with systemic lupus erythematosus (SLE). Carotid artery ultrasound (US) was found useful in identifying high CV-risk patients with inflammatory arthritis. We assessed the effect of carotid US assessments on the CV risk stratification of patients with SLE. METHODS: This cross-sectional study included 276 patients with SLE. These indices were measured: lipid profile, Systematic COronary Risk Evaluation (SCORE) risk calculation, and disease activity (SLE Disease Activity Index), severity (Katz), and damage [Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology Damage Index]. Carotid plaques were assessed by US. A multivariable regression analysis, adjusted for classic CV-related factors, was performed to evaluate how risk reclassification was influenced by disease characteristics in patients with SLE. RESULTS: Thirty-six percent of patients had carotid plaques. However, only 6% of them fulfilled the definitions for high or very high risk according to the SCORE risk charts. Following carotid US assessment, 32% of the patients were reclassified as very high risk. Disease duration (OR 1.04, 95% CI 1.00-1.07, p = 0.025) and a SLICC > 0 (OR 2.48 95% CI 1.15-5.34, p = 0.020) were independently associated with a higher risk of reclassification. A predictive model for reclassification included age (cutoff 52 yrs, sensitivity 60%, specificity 86%), disease duration (cutoff 24 yrs, sensitivity 40%, specificity 82%), presence of hypertension, SLICC > 0, waist circumference (cutoff 102 cm, sensitivity 48%, specificity 84%), and C3 (cutoff 127 mg/dl, sensitivity 52%, specificity 92%) and triglyceride (cutoff 140 mg/dl, sensitivity 68%, specificity 79%) serum levels. CONCLUSION: Reclassification into a very high-risk category is frequent after carotid US assessments in patients with SLE. This is independently influenced by disease damage.

 Autoría: Quevedo-Abeledo J.C., Rúa-Figueroa Í., Sánchez-Pérez H., Tejera-Segura B., De Vera-González A., González-Delgado A., Llorca J., González-Gay M.A., Ferraz-Amaro I.,

 Fuente: The Journal of Rheumatology, 2019, 46(5), 483-491

 Editorial: The Journal of Rheumatology Publishing Company Limited

 Año de publicación: 2019

 Nº de páginas: 9

 Tipo de publicación: Artículo de Revista

 DOI: 10.3899/jrheum.180881

 ISSN: 0315-162X

 Url de la publicación: https://doi.org/10.3899/jrheum.180881

Autoría

QUEVEDO-ABELEDO, JUAN C.

RÚA-FIGUEROA, ÍÑIGO

SÁNCHEZ-PÉREZ, HIURMA

TEJERA-SEGURA, BEATRIZ

VERA-GONZÁLEZ, ANTONIA DE

GONZÁLEZ-DELGADO, ALEJANDRA

FRANCISCO JAVIER LLORCA DIAZ

FERRAZ-AMARO, IVÁN