AB0323 INTIMA-MEDIA THICKNESS IS INDEPENDENTLY ASSOCIATED WITH STROKE IN PRIMARY ANTIPHOSPHOLIPID SYNDROME
Authors: L. D. Azoulay, A. Mathian, F. Cohen, J. Haroche, M. Pha, P. Cherin, P. Cluzel, Z. Amoura
Journal: Annals of the Rheumatic Diseases (2021)

Background: Compared to secondary antiphospholipid syndrome (APS), little is known on intima-media thickness (IMT) in primary APS. Previous reports suggest that intima-media thickness may be associated with anti-cardiolipin antibodies, anti-β2-glycoprotein-1 antibodies, and with stroke in APS 1 . Objectives: To assess clinical significance of intima-media thickness in primary APS. Methods: We have included 29 patients with primary APS (defined according to international consensus criteria) seen, at least once, in our tertiary center for a cardiovascular risk assessment from April 2014 to November 2018. Results: 29 patients were included (females 83%). Mean (SD) age at evaluation was 48 years (16.1). Mean APS duration before assessment was 9.1 years (6.2). 27 patients had thrombotic APS (93%), among which 13 (45%) had a history of arterial thrombosis (12 strokes and 1 myocardial infarction) and 16 (55%) of venous thrombosis. Obstetrical APS was present in 7 patients (24%). Positive APL antibodies were: anti-cardiolipin antibodies (aCL) n = 15 (54%), anti-β2-glycoprotein I (anti-β2GP1) n = 10 (36%), lupus-anticoagulant (LAC) n = 11 (39%) and anti-phospholipid antibodies (aPL) n = 19 (68%). Mean IgG levels (GPL) were 52.4 (80.3) UGPL, 52.2 (124) UI, 39.2 (40.5) UGPL for aCL anti-βG2P1, and aPL, respectively. 6 patients (21%) were simple positive, 3 (11%) were double positive, and 10 (36%) were triple positive. Cardiovascular risk factors were: smoking n = 6 patients (21%), overweight n = 11 (39%), hypercholesterolemia n = 12 (43%), arterial hypertension n = 11 (38%), chronic kidney disease (defined by estimated glomerular filtration rate &lt; 60 mL/mn) n = 5 (17%). No patient had diabetes mellitus. Median risk SCORE was 0.65 (0-2.4). Male sex, obesity, chronic kidney disease and risk SCORE were significantly more frequent in patients with arterial APS compared to patients with venous and/or obstetrical APS (38% vs 0%, P=0.01; 33% vs 0%, P=0.02; 38% vs 0%, P=0.01; 2.3 vs 0.7, P=0.03). 22 patients (76%) underwent an IMT measurement. Mean IMT was 0.57 (0.14) millimeters (mm). Median IMT was significantly higher in APS patient with stroke than in those without (0.63 IQR (0.55-0.77) mm versus 0.51 (0.44-0.55) mm, P=0.02) (Figure 1A). IMT was neither correlated with duration of APS nor with antibody titers. Variables associated with IMT were studied on uni- and multivariate analysis (Table 1). On univariate analysis, age, aCL positivity and stroke were significantly associated with IMT and were included in the multivariate analysis. On multivariate analysis, there was a positive, independent and significant association between IMT and stroke (P=0.047) and between IMT and age (P=0.024). aCL positivity was not associated with IMT on multivariate analysis (Figure 1B). Conclusion: Intima-media thickness is independently associated with stroke in primary antiphospholipid antibody syndrome. References: [1]Medina G. Increased carotid artery intima-media thickness may be associated with stroke in primary antiphospholipid syndrome. Ann Rheum Dis . 2003;62(7):607-610. doi:10.1136/ard.62.7.607 Characters from table content including title and footnotes. Table 1. Predictors of intima-media thickness on uni- and multivariate analysis. Univariate analysis Multivariate analysis* β P -value β P -value Age (years ) 0.006 &lt;0.001 0.004 0.024 Female sex -0.102 0.18 APS duration (years ) 0.0004 0.31 Smoker -0.05 0.61 Overweight 0.066 0.39 Arterial hypertension 0.047 0.48 Hypercholesterolemia 0.05429 0.412 Anti-cardiolipin antibodies 0.12 0.05 0.084 0.076 Anti-phospholipid antibodies 0.054 0.44 Anti-β2GP1 0.094 0.15 Lupus-anticoagulant 0.044 0.49 Anticoagulation -0.07 0.31 Stroke 0.139 0.02 0.099 0.047 β Linear regression coefficients APS Antiphospholipid antibody syndrome * Variables with a P -value &lt;0.1 on univariate analysis were included Figure 1. A. Intima-media thickness according to stroke status B. Multivariate analysis forest-plot of intima-media thickness predictors OR Odds-ratio aCL anti-cardiolipin antibodies Disclosure of Interests: None declared