Increased carotid intima thickness and decreased media thickness in premenopausal women with systemic lupus erythematosus: an investigation by non-invasive high-frequency ultrasound

Objective: To determine whether high-frequency ultrasound (US) yielding separate assessments of intima and media thickness gives additional information about the vascular morphology compared with the total common carotid artery intima-media thickness (CCA-IMT). Methods: Using a 22 MHz US instrument, we determined the near-wall CCA-IMT, the intima and media layers, and the intima/media (I/M) ratio in 47 premenopausal women with systemic lupus erythematosus (SLE), 20 healthy women, and 17 postmenopausal women (mean ages 37, 40, and 69 years, respectively). Results: In SLE, the carotid intima was thicker (0.19 +/- 0.04 vs. 0.12 +/- 0.02 mm), the media thinner (0.45 +/- 0.12 vs. 0.68 +/- 0.24 mm), the I/M ratio higher (0.45 +/- 0.17 vs. 0.20 +/- 0.07) (all p < 0.0001), and the CCA-IMT lower (0.64 +/- 0.13 vs. 0.80 +/- 0.25 mm, p < 0.01) compared to age-matched controls. The SLE patients had a thicker carotid intima compared to the postmenopausal women (0.19 +/- 0.04 vs. 0.14 +/- 0.03 mm, p < 0.0001) and a similar I/M ratio. Conclusion: Separate assessment of carotid artery wall layers demonstrated a thicker intima, thinner media, and a higher I/M ratio in women with SLE compared to healthy controls and indicated an artery wall status in SLE comparable to 30-years-older healthy women. Separate estimates of carotid intima and media layers may be preferable to CCA-IMT in SLE patients.