Carotid plaques in patients with long-term lupus nephritis

Objective: To evaluate the prevalence of carotid plaques in patients with long-term lupus nephritis (LN). Methods: Intima-media thickness (IMT) and carotid plaques were evaluated with ultrasound in 75 patients after a follow-up of LN of 158±106 months and in 75 sex -and age-matched controls. Traditional and non-traditional atherosclerotic risks factors were also tested. Results: IMT was not different between LN patients and controls, but 18% of LN patients had carotid plaques in comparison to 2.6% of controls (p=0.004). The LN patients more frequently had hypertension (p=0.0001), hypercholesterolemia (p=0.0001), were overweight (p=0.009), in menopause (p=0.01) than controls. More frequently, LN patients with carotid plaques had renal insufficiency (p=0.03), longer duration of lupus (p=0.05), anti-phospholipid antibodies (p=0.018), high C-reactive protein (p=0.03), high reactive oxygen species (p=0.001) than those without plaques. Patients with plaques were older (p=0.000001), in menopause (p=0.000001) and more frequently had cardio-vascular accidents during observation (p=0.02). The time of exposure to pathological values of systolic and diastolic blood pressure was longer (p=0.000001) and the percentage of pathological values of these variables during the follow-up was higher (p=0.000001) in patients with carotid plaques. At multivariate analysis, older age (p=0.0025), longer time of exposure to pathological values of blood pressure (p=0.015) and of cholesterol (p=0.04) were independent predictors of carotid plaques. Conclusions: Carotid plaques were more frequently found in LN patients than in controls. Although inflammatory markers and lupus related factors may contribute to the development of atherosclerosis, only traditional risk factors such as age, hypertension and hypercholesterolemia were the independent predictors.