ANTIBODIES TO ANNEXIN V INDEPENDENTLY PREDICT PROGRESSION OF CAROTID PLAQUE IN WOMEN WITH SLE

Background: Patients with SLE have an increased risk of developing accelerated atherosclerosis. Traditional cardiovascular (CV) risk factors do not fully account for this and SLE-specific factors have been implicated. In a previous cross-sectional study, we demonstrated that older age, smoking pack-years (pk-yrs) and antiphospholipid antibodies (aPL) were associated with carotid plaque. Objectives: To determine the association of classic CV risk factors, SLE-related factors and aPL subtypes with new plaque formation in SLE. Methods: In this longitudinal study, 85 female patients with SLE underwent carotid doppler ultrasound scans at baseline and follow-up at least 3 years later. At baseline, clinical data, SLE-related factors and CV risk factors were assessed, as well as serology by ELISA for IgG and IgM antibodies to cardiolipin, β2-glycoprotein-I, prothrombin and annexin-V (anti-ANX-V) (AESKU Diagnostics, Germany). The primary outcome measure was the presence of new carotid plaque at follow-up. Chi-square, Mann-Whitney U and binary logistic regression tests were performed to determine associations. Results: We studied 85 SLE patients with a mean (SD) age of 50.0 (9.7) years who had follow-up scans 4.4 (0.6) years later. Carotid plaque was present in 25 (29.4%) patients at baseline and in 42 (49.4%) at follow-up. Baseline predictors of new plaque formation at follow-up included older age (56.3 [7.3] vs 46.0 [9.0] yrs, p<0.0001), older age at SLE diagnosis (44.1 [12.1] vs 33.4 [9.9] yrs, p=0.0001), smoking pk-yrs (median [IQR] 3.5 [0,22.8] vs 0 [0,4.4] pk-yrs, p=0.001) systolic blood pressure (140 [IQR 129,152], vs 121 [112.2,140.0] mmHg, p=0.003), triglycerides (TG) levels (1.20 [IQR 1.00,1.65], vs 0.90 [0.70,1.30] mmol/l, p=0.01), estimated glomerular filtration rate (72.6 [IQR 57.0,83.0], vs 84.2 [67.5,99.7] mL/min, p=0.01) and lower SLEDAI scores (0 [IQR 0,2], vs 2 [0,4], p=0.01). By multivariate analysis, the independent risk factors were older age (OR 1.19, 95%CI:1.10,1.30), TG levels (OR 2.91, 95%CI:1.04,8.17) and positive anti-ANX-V IgG (OR 7.93, 95%CI:1.10,57.03). This model had an AUC ROC=0.847, p<0.0001. Conclusions: Traditional CV risk factors and SLE-related factors predict atherosclerotic carotid plaque formation in SLE. Our results also support the hypothesis that impaired annexin-V binding to endothelial cells may enhance the propensity to atherosclerosis development in SLE patients. References: 1. Ahmad Y et al. Subclinical atherosclerosis in systemic lupus erythematosus (SLE): The relative contribution of classic risk factors and the lupus phenotype. Rheumatology 2007;46:983-8. Disclosure of Interest: None DeclaredCitation: Annals of the Rheumatic Diseases, volume 70, supplement 3, year 2011, page 496Session: Lupus Rounds (Poster Presentations )