Impaired HDL cholesterol efflux capacity in systemic lupus erythematosus patients is related to subclinical carotid atherosclerosis

Abstract

Objectives Lipid profiles appear to be altered in SLE patients due to disease activity and inflammation. Cholesterol efflux capacity (CEC) is the ability of high-density lipoprotein cholesterol to accept cholesterol from macrophages. CEC has been linked to cardiovascular events in the general population and is impaired in SLE patients. The aim of this study was to establish whether CEC is related to subclinical carotid atherosclerosis in SLE patients. Methods The present report is of a cross-sectional study that encompassed 418 individuals: 195 SLE patients and 223 controls. CEC, using an in vitro assay, and lipoprotein serum concentrations were assessed in patients and controls. Carotid intima-media thickness and carotid plaques were evaluated in SLE patients. A multivariable analysis was performed to study the relationship of CEC to SLE-related data, lipid profile and subclinical carotid atherosclerosis. Results CEC was downregulated in SLE patients [8.1 (4.2) % vs 16.9 (10.4) %, P = 0.004). This occurred independently of traditional cardiovascular risk factors, statin use or other variations in the lipid profile related to the disease. Traditional cardiovascular risk factors, both in patients and controls, and SLE-related data such as activity, severity or damage were not associated with CEC. After multivariable regression analysis including lipid profile–related molecules, CEC was inversely and independently associated with the presence of carotid plaques in SLE patients [odds ratio 0.87 (95% CI: 0.78, 0.97), P = 0.014]. Conclusion CEC is impaired in SLE patients independently of other inflammation-related lipid profile modifications that occur during the disease. CEC is associated with carotid plaques in SLE patients.

High Density Lipoprotein Cholesterol Efflux Capacity and Atherosclerosis in Cardiovascular Disease: Pathophysiological Aspects and Pharmacological Perspectives

“…HDL CEC impairment has been reported in various rheumatologic autoimmune diseases, such as RA and systemic lupus erythematosus (SLE) [190][191][192][193][194]. In SLE, HDL CEC was inversely related to subclinical carotid atherosclerosis [195]. In our study [191], in RA ABCG1-mediated CEC was specifically impaired and inversely related to the disease activity score DAS28.…”

Changing Perspectives on HDL: From Simple Quantity Measurements to Functional Quality Assessment

“…Studies performed in patients with metabolic syndrome or diabetes have also reported impaired HDL cholesterol efflux capacity to be an independent risk factor for the development of atherosclerosis [ 27 – 29 ]. Several studies have reported that impaired CEC is linked to the development of cardiovascular outcomes in patients in the context of inflammatory diseases like rheumatoid arthritis [ 30 ], systemic lupus erythematosus [ 31 ], and psoriatic arthritis [ 32 ].…”

HDL-Cholesterol Efflux Capacity and Lipid Profile in Patients with Systemic Sclerosis.

“…Evidence suggests that CEC has a strong inverse association with carotid intimamedia thickness (cIMT), the likelihood of angiographic coronary artery disease, independent of HDLcholesterol levels [3], and with the incidence of cardiovascular (CV) events in a population-based cohort [4]. Regarding to rheumatic diseases, it has been demonstrated that CEC is disrupted in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) [5], a nding associated with an increased subclinical atherosclerosis in both diseases [6,7]. Systemic sclerosis (SSc) is a chronic autoimmune disease characterized by endothelial dysfunction, microvascular damage, in ammation, impaired coagulation/ brinolysis and increased tissue brosis [8], and enhanced cardiovascular risk [9].…”