Arterial stiffness in different age and cardiovascular risk groups of patients with systemic lupus erythematosus

OBJECTIVE: SLE is associated with increased cardiovascular morbidity and mortality. Although arterial stiffness (ArS) is a well-recognized surrogate marker of cardiovascular risk in the general population, its role in SLE is uncertain. We examined the prevalence of ArS in SLE vs healthy controls (HCs), potential ArS predictors and associations with subclinical atherosclerosis. METHODS: ArS was assessed in 194 SLE patients and 194 age/sex/mean arterial pressure (MAP)-matched HCs using the carotid-femoral pulse wave velocity (cfPWV) and augmentation index at 75 beats/min (AΙx@75). Atherosclerotic plaque presence was evaluated in all participants using carotid/femoral ultrasonography. ArS was examined in different age (18-37, 38-57, 58-75 years) and cardiovascular risk (low-moderate/high-very high) groups, classified by Systematic Coronary Risk Evaluation (SCORE) and plaque presence. Linear regression models identified ArS predictors, including traditional and disease-related cardiovascular risk factors (CVRFs). RESULTS: SLE patients had increased AΙx@75 (β = 3.458, P =0.014) vs HCs, but not cfPWV (P = 0.578). Patients aged 18-37 had higher cfPWV (P = 0.028) and AIx@75 (P < 0.001) than HCs. Low-moderate risk patients had higher AΙx@75 than HCs (P = 0.029), and after reclassification by plaque presence (P = 0.009). Both cfPWV (P = 0.042) and AΙx@75 (P = 0.0141) were independently associated with atherosclerotic plaques. In SLE, cfPWV and AIx@75 were associated with age (P < 0.001 for both), MAP (P < 0.001 for both) and sum of modifiable CVRFs (hypertension, dyslipidaemia, smoking, exercise, body weight) (P = 0.013 and P = 0.006, respectively). cfPWV was also associated with SCORE (P < 0.001). CONCLUSION: Increased ArS in SLE and associations with subclinical atherosclerosis highlights its importance in cardiovascular risk stratification, particularly in young low/moderate-risk adults.