目标:2022年EULAR风湿性疾病患者心血管风险管理建议,包括系统性红斑狼疮(SLE),呼吁对心血管危险因素(CVRF)进行严格的管理。在前瞻性超声研究中,尚未评估达到CVRF目标对动脉粥样硬化斑块进展的影响。
方法:在我们的心血管研究单位进行基线颈动脉和股动脉超声检查的115例SLE患者和1:1年龄和性别匹配的健康对照者,被邀请对新斑块的发展进行为期7年的随访评估。我们旨在比较SLE患者和对照组之间斑块进展的发生率,并揭示其在多大程度上受到欧洲心脏病学会(ESC)可变CVRF目标的影响(血压,吸烟状况,体重,脂质,和身体活动),和疾病相关特征(疾病持续时间,疾病活动,自身抗体,治疗)。
结果:86例SLE患者和42例对照者接受了7年随访颈动脉和股动脉斑块检查。在32/86名患者中观察到新的斑块发展,而8/42名对照(p=0.037)。SLE患者斑块进展风险比对照组高4倍(OR:4.16,CI:1.22-14.19,p=0.023),调整潜在的混杂因素。多因素回归分析显示,每个可修改的CVRF满足ESC目标的斑块进展减少了50%(OR:0.56,CI:0.34-0.93,p=0.026)。
结论:SLE患者发展动脉粥样硬化斑块的快速进展,根据ESC指南,通过达到CVRF目标可能会急剧减少。
OBJECTIVE: The 2022 EULAR recommendations for cardiovascular risk management in patients with rheumatic disorders, including SLE, call for rigorous management of cardiovascular risk factors (CVRF). The impact of CVRF target attainment on atherosclerotic plaque progression hasn\'t been previously evaluated in prospective ultrasound studies.
METHODS: A total of 115 patients with SLE and 1:1 age and sex-matched healthy controls who had a baseline carotid and femoral ultrasound examination in our cardiovascular research unit were invited for a 7-year follow-up assessment of new plaque development. We aimed to compare the incidence of plaque progression between SLE patients and controls and reveal the extent to which it is affected by the attainment of European Society of Cardiology (ESC) targets for modifiable CVRFs (blood pressure, smoking status, body weight, lipids and physical activity), and disease-related features (disease duration, disease activity, autoantibodies, treatments).
RESULTS: Eighty-six SLE patients and 42 controls had a 7-year follow-up carotid and femoral plaque examination. New plaque development was observed in 32/86 patients vs 8/42 controls (P = 0.037). Patients with SLE had a 4-fold higher risk for plaque progression than controls (OR: 4.16, CI: 1.22, 14.19, P = 0.023), adjusting for potential confounders. Multivariate regression analyses showed a 50% decrease in plaque progression for every modifiable CVRF fulfilling ESC targets (OR: 0.56, CI: 0.34, 0.93, P = 0.026).
CONCLUSIONS: Patients with SLE develop a rapid progression of atherosclerotic plaques which may be drastically reduced by CVRF target attainment according to ESC guidelines.