THU0256 RISK OF LONG-TERM INCIDENT CARDIOVASCULAR EVENT AND MORTALITY IN PATIENTS WITH SLE AND POPULATION CONTROLS IS ASSOCIATED WITH A HIGHER CAROTID INTIMA-MEDIA THICKNESS
Authors: Sofia Ajeganova, Ingiäld Hafström, Johan Frostegård
Journal: Annals of the Rheumatic Diseases (2019)

<h3>Background:</h3> Measurement of carotid intima-media thickness (cIMT) is promoted as one of the tools for cardiovascular (CV) risk assessment in primary prevention in general population. The diagnosis of systemic lupus erythematosus (SLE) is a strong risk factor for premature CV events and mortality. Whether assessment of cIMT has a value for prediction of CV morbidity and mortality in patients with SLE compared with population controls of similar age and sex is not established. <h3>Objectives:</h3> To examine association of cIMT with risk of incident CV events and mortality in SLE and controls. <h3>Methods:</h3> We used the cross-sectional SLEVIC (SLE vascular impact cohort study) cohort of consecutive patients with SLE aged &lt;70 years who were regularly treated in a tertiary referral rheumatology center. Carotid ultrasound was performed at inclusion to the cohort (from September 2006 to January 2008) in 118 patients and in 122 population controls matched by age and sex. Incident CV events were defined as hospitalization for angina pectoris, myocardial infarction, bypass grafting, percutaneous coronary or peripheral artery intervention, ischemic stroke and TIA. Combined outcome of incident CV event and all-cause mortality was evaluated for a mean (SD) follow-up of 9.6 (1.5) years. Participants with prevalent CV before inclusion, n=18, and those who were lost to follow-up, n=14, were excluded from this analysis. Event-free survival rates in patients and controls were compared using Kaplan-Meier curves. Relative hazard ratios from Cox proportional-hazards regression models were used to estimate the effect of cIMT measurement on the outcome. <h3>Results:</h3> At inclusion, mean age (SD) of the included 99 patients was 47 (13) years, 87% females, mean disease duration 12 (9) years, SLEDAI 4.0, and SLICC/ACR 1.0. Mean age of included 109 controls was 49 (12) years, 91% females. Baseline mean (SD) cIMT did not differ between the groups (p=0.345) and was 607 (127) µm in patients and 623 (118) µm in controls. During follow-up, 12 patients and 4 controls were defined with the outcome. The outcome was reached more often in patients than in controls, p=0.022. The mean time to outcome (SD) was 9.9 (0.2) years for patients and 10.3 (0.1) years for controls. The hazard rate (HR) for the combined outcome of CV event and mortality was 3.7-fold (95% CI, 1.2–11.5) higher in patients than in controls, adjusted for age, sex and smoking history, p=0.025. A higher baseline mean cIMT was significantly associated with the outcome, HR 1.0 (95% CI, 1.0-1.01) per 1.0 µm increase in cIMT, p=0.040, irrespective of the group. Additional adjustment for traditional risk factors, disease duration, treatments, presence of anti-phospholipid antibodies and defining with carotid plaque yielded similar risk estimates. <h3>Conclusion:</h3> In this analysis we confirm an elevated long-term risk of important adverse clinical events in patients with SLE compared with controls. A measure of cIMT is associated with incident CV event and mortality. This suggests that assessment with carotid ultrasound may have a value for CV risk stratification and would encourage validation in large-cohort prospective populations. <h3>Disclosure of Inter:</h3> Sofia Ajeganova: None declared, Ingiäld Hafström: None declared, Johan Frostegård Shareholder of: Minor shareholder and inventor in startup-company Athera Biotechnologies, but they do not produce drugs yet and rheumatology is not in their focus.