Study Identifies Risk Factors for Carotid Intima Media Thickness Progression in SLE

Women with systemic lupus erythematosus (SLE) were twice as likely to experience carotid plaque buildup during the 5 years of this study.

Women with systemic lupus erythematosus (SLE) may be able to curb progression of carotid intima media thickness (IMT) and plaque by modifying certain risk factors, a new report suggests.

The study sought to find out which factors make patients with SLE more likely to experience carotid IMT progression by comparing women with SLE with a control group. The findings were published in the journal Lupus Science & Medicine.

Corresponding author Julia Sun, MD, of the Northwestern University Feinberg School of Medicine, and colleagues explained that while cardiovascular disease is a well-known complication of SLE, efforts to study its pathogenesis by examining atherosclerosis in these patients has thus far yielded limited insights.

The investigators said certain atherosclerosis-related metrics, such as carotid IMT and plaque progression, have been found to be associated with factors such as SLE duration and comorbid depression. Yet, most of the earlier longitudinal studies have had follow-up periods of 2-3 years. In this new study, the investigators wanted to use a longer time horizon of 5 years.

Sun and colleagues began with patients who were enrolled in the Study of Lupus Vascular and Bone Long-term Endpoints (SOLVABLE). A total of 149 women with SLE and 126 healthy controls were included in the current report, and evaluated for baseline characteristics including cardiovascular and SLE factors. B-mode ultrasound was used to measure carotid IMT and plaque at baseline and then after 5 years. The authors then used regression and multivariate models to identify potential risk factors.

Among patients with SLE, the authors found a mean change in IMT of 0.008 [0.015] mm versus 0.005 [0.019] mm in the healthy controls. In terms of plaque buildup, the authors noted that at baseline, 37% of patients with SLE and 40% of the healthy controls had observable plaque. After 5 years, though, nearly one-third of patients with SLE (31.5%) had experienced plaque progression, double the rate of the healthy controls (15%). The relative risk for plaque progression among patients with SLE was likewise 2.09 (95% CI, 1.30-3.37).

The study elucidated a number of risk factors for IMT and plaque progression.

“In this 5-year follow-up study, we found that among SLE cases, higher fasting glucose and lower fibrinogen were independent predictors of carotid IMT progression; large waist circumference and non-use of HCQ [hydroxychloroquine] were independent predictors of plaque progression,” they found.

SLE itself was found to be an independent risk factor for carotid plaque progression, but not for carotid IMT progression.

Sun and colleagues said more research will be needed to fully understand the apparent risk factors, and they noted that their study, even with 5 years’ follow-up, might not be long enough to capture distinct changes in IMT or plaque.

Still, they said the study is helpful in describing potentially modifiable risk factors that could be controlled with careful attention from patients and physicians.

“While better screening for these risk factors and earlier implementation of lifestyle modifications are essential, future research is needed to examine the longitudinal efficacy and safety of interventions including HCQ use in alleviating metabolic syndrome and the progression of atherosclerosis in patients with SLE,” they concluded. “The implementation of an inception cohort may be a reasonable study approach to begin to answer these questions.”


Lertratanakul A, Sun J, Wu PW, et al. Risk factors for changes in carotid intima media thickness and plaque over 5 years in women with systemic lupus erythematosus. Lupus Sci Med. 2021;8(1):e000548. doi:10.1136/lupus-2021-000548