The Relationships of High-Sensitivity C-Reactive Protein and Homocysteine Levels With Disease Activity, Damage Accrual, and Cardiovascular Risk in Systemic Lupus Erythematosus

Abstract

Chronic inflammation coupled with cardiovascular disease (CVD) risk factors influences the progression of atherosclerosis in systemic lupus erythematosus (SLE). High-sensitivity C-reactive protein (hs-CRP) and homocysteine (Hcy) are associated with the risk of CVD in the general population, but their associations with CV risk and disease activity in SLE are unclear. In this cross-sectional study ( N = 139 SLE patients, mean age = 45.27 ± 13.18 years), we investigated associations between hs-CRP and Hcy levels and disease activity, damage accrual, and CVD risk in SLE. Disease activity and damage accrual were measured with the SLE Activity Index 2000 (SLEDAI-2K), the Systemic Lupus Erythematosus International Collaborating Clinics Group/American College of Rheumatology damage index (SDI), and anti-double-stranded DNA antibodies (anti-dsDNA). CVD risk factors of obesity, diabetes mellitus, hypertension, blood lipids, and ankle–brachial index were collected. Linear regression analysis and one-way analysis of variance were used to analyze relationships of hs-CRP and Hcy with SLE activity, damage accrual, and CVD risk factors. Results: hs-CRP correlated significantly with SLEDAI-2K ( p = .036), SDI ( p = .00), anti-dsDNA titers ( p = .034), diabetes ( p = .005), and obesity ( p = .027). hs-CRP and Hcy correlated with triglyceride (TG) levels ( p = .032 and p < .001, respectively), TG/high-density lipoprotein cholesterol index ( p = .020 and p = .001, respectively), and atherogenic index of plasma ( p = .006 and p = .016, respectively). hs-CRP levels >3 mg/L correlated with SDI score ( p = .012) and several CVD risk factors. Discussion: Findings suggest SLE patients with elevated hs-CRP and/or Hcy have a higher prevalence of CVD risk factors.

CRP Serum Levels Are Associated with High Cardiometabolic Risk and Clinical Disease Activity in Systemic Lupus Erythematosus Patients

“…Our results agree with previous studies conducted on SLE populations that reported a correlation between CRP levels and lipid profile alterations, diabetes, obesity, and BMI. They also found that triglyceride levels and the triglycerides/HDL-C ratio positively correlated with CRP levels [ 11 ].…”

“…Mok et al reported that CRP levels were detectable in 77% of SLE patients, and CRP correlated with SLEDAI scores in SLE patients from USA [ 36 ]. Another study conducted on SLE patients from Spain also showed a significant correlation between CRP levels and the clinical disease activity assessed by the SLEDAI-2K score [ 11 ].…”

“…Concerning the pathogenic role of CRP in autoimmune diseases, it has been reported that SLE patients could have higher CRP serum levels compared to healthy controls [ 10 ], and the CRP serum levels correlate with traditional cardiovascular risk factors such as dyslipidemia, obesity, and glucose disturbances, which could be associated with a negative impact on robust outcomes such as damage, disease activity, and survival in SLE [ 11 ].…”

“…Nevertheless, it is widely described that in active SLE patients there is an increase in inflammatory cytokines such as IL-6, which could directly drive the CRP serum levels, suggesting a potential relationship between the increase in IL-6 in the active SLE and higher CRP serum levels [ 7 ]. Previous studies have described that CRP serum levels correlate with clinical disease activity when evaluated by the SLEDAI-2K index, where it is proposed that CRP levels could reflect the clinical disease activity in SLE [ 11 ]. Notably, SLE patients have high cardiometabolic risk, which has been related to a high clinical disease activity [ 14 ].…”

Dysregulated serum lipid profile and its correlation to disease activity in young female adults diagnosed with systemic lupus erythematosus: a cross-sectional study

“…It has been shown that the patients with active SLE exhibited upregulation of TG and VLDL-C levels and downregulation of HDL-C levels, suggesting that dyslipidemia was aggravated in active SLE [22,24], demonstrating aggravated dyslipidemia in the patients with inactive SLE [25]. In accordance with these results, our study by univariate correlation analyses revealed negative correlations between SLEDAI and HDL-C, LDL-C, Apo A, and Apo B; positive correlations between SLEDAI and TG, and VLDL-C, also indicating that SLE disease activity is strongly associated with the changes of lipid profile.…”