Lupus nephritis as an independent risk factor for carotid atherosclerosis in patients with systemic lupus erythematosus

Abstract

Objective: Systemic lupus erythematosus (SLE) is associated with an elevated risk of atherosclerosis, with lupus nephritis (LN) representing a critical and potentially fatal target organ damage. This study aims to investigate the prevalence of LN in SLE patients, and its correlation with carotid atherosclerosis (CA).

Methods: A total of 151 SLE patients (age, 50.9 ± 14.6 years, 87.4% women) were included in the study. The 2024 KDIGO guideline was used to assess the LN prevalence, and carotid artery ultrasound was performed to identify plaque and intima-media thickness (IMT). The correlation between LN and CA in SLE patients was evaluated, and logistic regression analysis was conducted to identify CA risk factors.

Results: A total of 47.0% of SLE patients exhibited LN, and the prevalence of CA was 37.7%. Patients with LN exhibited a higher carotid plaque ratio (47.9% vs 28.7%, p = 0.015) and IMT values [1.0(0.7, 1.1) mm vs. 0.8(0.7, 1.0) mm, p < 0.010] compared to those without LN. The presence of LN (p = 0.002), male sex (p = 0.039), age (p < 0.001), and serum TC (total cholesterol) (p = 0.016) were independent risk factors for SLE patients with CA. LN and related renal parameters demonstrated a strong association with CA in patients with SLE.

Conclusion: The prevalence of LN was significantly correlated with CA in SLE patients, indicating that early identification of LN in SLE patients has a high risk of CA, which may facilitate targeted prevention and reduce cardiovascular morbidity. Key Points • Lupus nephritis (LN) was present in 47.0% of systemic lupus erythematosus (SLE) patients, and carotid atherosclerosis (CA) was prevalent in 37.7% of the study. • Systemic lupus erythematosus (SLE) patients with lupus nephritis (LN) exhibited significantly higher carotid plaque ratios and increased intima-media thickness compared to those without LN. • The presence of lupus nephritis (LN), male sex, advanced age, and elevated total cholesterol levels was identified as independent risk factors for carotid atherosclerosis (CA) in patients with systemic lupus erythematosus (SLE).

Keywords: Carotid atherosclerosis; Lupus nephritis; Risk factors.