What is the clinical evidence from this study?

Study design: Cohort. Population: Systemic lupus erythematosus (SLE) (n=99). Intervention: Presence of coronary artery calcification (CAC) at baseline vs. Absence of CAC at baseline. Primary outcome: Coronary artery calcification (CAC) progression (RR 2.52, 95% CI 1.68-3.78, p=<0.001).

January 13, 2025Open Access

Coronary artery calcification progression and renal involvement in patients with systemic lupus erythematosus: a longitudinal cohort study

Q: What are the key findings of this study?

In patients with systemic lupus erythematosus, the prior presence of coronary artery calcification was associated with a 2.52-fold increased relative risk of calcification progression over 5 years.

Q: What does this research mean for the field?

In patients with systemic lupus erythematosus, the prior presence of coronary artery calcification is associated with a 2.52-fold increased relative risk of calcification progression over 5 years, along with smoking and longer disease duration. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

LZLise ZinglersenCopenhagen University Hospital AZAmanda Hempel ZinglersenCopenhagen University Hospital KMKatrine Aagaard MyhrCopenhagen University Hospital

Key Result

In patients with systemic lupus erythematosus, the prior presence of coronary artery calcification was associated with a 2.52-fold increased relative risk of calcification progression over 5 years.

Study Design

Type

Cohort (n=99)

Multicenter

Structured PICO

Population

99 patients with systemic lupus erythematosus (SLE) who completed baseline and 5-year follow-up cardiac CT (from an original cohort of 147). Mean age 47 years, 88% female, 95% Caucasian, median SLE disease duration 14.3 years, 58% with lupus nephritis, median eGFR 99 mL/min/1.73m2. Based in Denmark.

Outcome

Progression of coronary artery calcification (CAC), defined as a difference of ≥ 2.5mm3 in the square volume of the total plaque in the coronary arteries between baseline and 5-year follow-upsurrogate

In patients with systemic lupus erythematosus, progression of coronary artery calcification over 5 years is common (39%) and is driven by traditional risk factors like smoking as well as disease duration and baseline calcification, rather than renal involvement.

Main Result

Effect estimate: RR 2.52 (95% CI 1.68-3.78)

p-value: p=<0.001

Limitations

Limited cohort size with a low number of myocardial infarction events during follow-up.
Lack of a control group from the general population to estimate specific attribution of disease-related exposure.
Skewed proportion of patients with lupus nephritis at follow-up (58%) compared to the general SLE population, potentially compromising generalizability.
Inability to measure disease and treatment-related exposures prior to the study start.

Abstract

Abstract To investigate if progression of coronary artery calcification (CAC) in patients with systemic lupus erythematosus (SLE) is associated with renal and traditional cardiovascular risk factors as well as incidence of myocardial infarctions. CAC progression was evaluated by cardiac computed tomography (CT) at baseline and after 5 years. Multivariable Poisson regression was applied to investigate associations between CAC progression and baseline values for traditional cardiovascular risk factors, CAC, SLE disease duration, lupus nephritis, and renal function. Regarding renal function, three groups were defined based on eGFR. Further, we analysed association between CAC progression and myocardial infarction during follow-up. Of the 147 SLE patients, 99 had cardiac CT at baseline and 5-year follow-up, with a total of 502 patient-years. At baseline, their median age was 47 years, median SLE disease duration was 14 years, 88% were women, 58% had lupus nephritis, and the median eGFR was 99 mL/min/1.73m 2 . 38/99 (39%) had CAC progression. CAC progression was associated with smoking (ever) (relative risk RR 1.69, CI95% 1.19–2.40), SLE disease duration (RR per year 1.03, CI95% 1.01–1.04), and CAC presence (RR 2.52, CI95% 1.68–3.78) at baseline. During follow-up, myocardial infarction occurred in three (7.9%) CAC progressors and in two (3.3%) patients who did not have CAC at any time (RR 2.1, CI95% 0.0-5.5). In this study, progression of CAC was associated with smoking, SLE disease duration and the prior presence of CAC, but it was inconclusive as to associations with renal involvement and incidence of MI.

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