A high-risk PREDICTS profile combining biomarkers and traditional risk factors predicted increased odds of carotid plaque presence and progression in SLE patients.Patients with a high-risk profile had a 28-fold increased odds of plaque presence.Age ≥48 years, high piHDL function, leptin levels ≥34 ng/dl, and high sTWEAK levels were strong predictors of carotid plaque. The gene discussed is LEP; the disease is systemic lupus erythematosus.