Eur J Intern Med. 2026 Aug 29:107169. doi: 10.1016/j.ejim.2026.107169. Online ahead of print.
ABSTRACT
BACKGROUND: Systemic lupus erythematosus (SLE) is associated with increased cardiovascular morbidity, but the long-term prognostic value of subclinical atherosclerosis and circulating biomarkers remains uncertain. We aimed to assess 10-year vascular outcomes and identify clinical and biological predictors of thrombotic events in SLE.
METHODS: This prospective cohort study included 97 consecutive female patients with SLE who underwent baseline clinical, laboratory, and carotid ultrasound evaluation and were followed for a mean of 9.7 ± 2.8 years. Carotid intima-media thickness (IMT) and plaque were assessed according to standardized criteria. Traditional cardiovascular risk factors, lupus-related variables, and biomarkers including adipokines, inflammatory mediators, endothelial activation markers, and osteoprotegerin were analyzed. Cardiovascular events were confirmed by medical record review. Logistic and Cox regression models were used to identify predictors. Arterial events were compared with an age-matched population-based cohort.
RESULTS: Carotid plaques were present in 44% of patients at baseline. During follow-up, 11 patients (11.3%) experienced thrombotic cardiovascular events, including eight arterial events. Metabolic syndrome (29.4% vs. 6.5%, p = 0.006) and hypertension (22.2% vs. 7.1%, p = 0.036) were associated with increased risk. In Cox analysis, metabolic syndrome independently predicted events (HR 4.3, 95% CI 1.2-15.2, p = 0.012), while age was the strongest independent determinant of both overall and arterial events. Higher IMT, cumulative damage, and reduced renal function were associated with adverse outcomes. An independent prognostic association between most inflammatory and adipokine biomarkers could not be demonstrated within our cohort. Compared with controls, SLE patients showed numerically higher arterial event rates, although differences were not statistically significant.
CONCLUSIONS: Long-term cardiovascular risk in SLE appears to be driven mainly by age, metabolic abnormalities, and cumulative organ damage rather than by lupus-specific inflammatory biomarkers.
PMID:42665520 | DOI:10.1016/j.ejim.2026.107169
