Atherosclerotic plaque progression and incident cardiovascular events in a 10‐year prospective study of patients with Systemic Lupus Erythematosus: the impact of persistent cardiovascular risk factor target attainment and sustained DORIS remission

ObjectiveCardiovascular disease is a leading cause of mortality in Systemic Lupus Erythematosus (SLE). We assessed atherosclerotic plaque progression and incident cardiovascular events in SLE patients over a 10‐year follow‐up.MethodsWe prospectively analyzed 738 carotid ultrasound measurements (413 in SLE patients and 325 in age/sex‐matched healthy controls [HC]) to assess new plaque development from baseline to 3‐, 7‐, and 10‐year follow‐up. Multivariate mixed Poisson regression models examined potential predictors of plaque progression, including patient characteristics, Systemic Coronary Risk Evaluation (SCORE), traditional cardiovascular risk factor (CVRF) target attainment, Definition of Remission in SLE (DORIS), medications, and persistent triple antiphospholipid antibody (aPL) positivity during follow‐up. Ten‐year incident cardiovascular events were recorded, and univariate Cox regression analysis assessed potential associations.ResultsSLE patients had a 2.3‐fold higher risk of carotid plaque progression than HC (Incidence Rate Ratio [IRR]: 2.26; p=0.002). Plaque progression risk in SLE was reduced by 32% (IRR: 0.68, p=0.004) per each sustainedly attained CVRF target during follow‐up, including blood pressure, lipids, smoking, body weight, and physical activity. DORIS achievement ≥75% of follow‐up was associated with a 43% decrease in atherosclerosis progression risk (IRR: 0.57; p=0.033). Ten‐year risk of incident cardiovascular events was higher in SLE than HC individuals (eight versus one event, permutation‐based log‐rank p=0.036) and was associated with persistent triple aPL positivity.ConclusionPatients with SLE experience a 2.3‐fold higher 10‐year atherosclerosis progression risk than HC, mitigated by sustained CVRF control and prolonged clinical remission. Persistent triple aPL positivity is associated with increased incidence of CVD events.