Subclinical atherosclerosis in asymptomatic carriers of persistent antiphospholipid antibodies positivity: A cross-sectional study

Background:Whereastherelationshipbetweensubclinicalatherosclerosisandantiphospholipidsyndrome(APS) hasbeenwidelyinvestigated,littleisknownaboutsubclinicalatherosclerosisinasymptomaticcarrierswithisolated antiphospholipid antibodies positivity (APP). Methods:Consecutive APPcarriers, APS subjectsand matchedcontrolswere enrolled.Intima-mediathickness of the common carotid artery (CCA-IMT) and of the Bulb (Bulb-IMT) and the prevalence of carotid plaques were assessed in all enrolled subjects. Results: A total of 104 APP carriers, 221 APS subjects, and 325 matched controls were recruited. As compared with controls, APP carriers and APS subjects showed a higher CCA-IMT (0.90 ± 0.24 vs 0.82 ± 0.12, p = 0.014 and 0.93 ± 0.42 vs 0.82 ± 0.12, pb 0.001, respectively), Bulb-IMT (1.10 ± 0.44 vs 0.95 ± 0.18, p = 0.006 and 1.22 ± 0.68 vs 0.95 ± 0.18, pb 0.001, respectively) and an increased prevalence of carotid plaques (33.7% vs 10.2%,pb0.001and38.5%vs10.2%,pb0.001,respectively).Theseresultswereconfirmedstratifyingforantibody isotype, after excluding subjects with systemic lupus erythematosus or other autoimmune diseases and after adjustingformajorclinicalanddemographicvariables.CCA-IMT,Bulb-IMTandtheprevalenceofcarotidplaques were higherin subjects with high-titerantibodiesand progressively increased for an increasing numberof positive antibodies. Conclusions: Similar to APS subjects, APP carriers have enhanced subclinical atherosclerosis, a more severe disease being observed in the presence of high-titer antibodies and multiple antibodies positivity. These data argue for a strict monitoring of subclinical signs of atherosclerosis and of cardiovascular risk factors in asymptomatic APP carriers.