Atherosclerosis progression in antiphospholipid syndrome is comparable to diabetes mellitus: a 3 year prospective study.

Background: Antiphospholipid syndrome (APS) is an autoimmune thrombophilia leading to life-threatening cardiovascular events. Cross-sectional data support that APS is associated with accelerated atherosclerosis, but this has not been confirmed in prospective studies. We aimed to compare the rate of atherosclerosis progression over a 3 year period between patients with APS, diabetes mellitus (DM) and healthy controls (HCs).

Methods: Eighty-six patients with APS [43 with primary APS (PAPS), 43 with SLE-related APS (SLE-APS)] and an equal number of age- and sex-matched patients with DM and HCs who underwent a baseline US of the carotid and femoral arteries were invited for a 3 year follow-up evaluation for atherosclerotic plaque progression. Multivariate analysis was performed for the assessment of determinants of plaque progression after adjustment for disease-related and traditional cardiovascular risk factors.

Results: Seventy-four APS patients (74.3% female, 38 with PAPS), 58 DM patients and 73 HCs were included. APS patients exhibited a 3.3-fold higher risk of new atherosclerotic plaque formation compared with HCs (P = 0.031), similar to that in DM [odds ratio (OR) 3.45, P = 0.028]. In APS patients, plaque development risk was higher in SLE-APS vs PAPS (OR 7.75, P = 0.038) and was independently associated with the presence of traditional cardiovascular risk factors as expressed by the Systematic Coronary Risk Evaluation risk (OR 2.31, P = 0.008).

Conclusion: APS is characterized by accelerated rates of subclinical atherosclerosis to a degree comparable to DM, which is more pronounced in SLE-APS patients. Traditional cardiovascular risk factors are major determinants of this risk, warranting aggressive management as in other disorders with high cardiovascular risk.