Traditional and non-traditional risk factors contribute to the development of accelerated atherosclerosis in patients with systemic lupus erythematosus

Abstract

To determine risk factors of accelerated atherosclerosis in patients with systemic lupus erythematosus (SLE), 72 patients with inactive disease and 36 age- and sex-matched controls were included. The intima-media thickness (IMT) of the common carotid artery was determined by ultrasound. Traditional risk factors and disease-related factors were recorded. Cardiovascular risk was estimated using SCORE (systematic coronary risk evaluation). Markers of inflammation, endothelial activation and vascular remodelling (matrix metalloproteinases (MMP-3, MMP-9) and tissue inhibitor of metalloproteinase- 1 (TIMP- 1)) were determined. IMT was increased in patients (0.67 mm+/-0.13 versus 0.61 mm+/-0.11, P < 0.05). Prevalence of hypertension (33% versus 6%, P < 0.001), SCORE (2.2 (1.7-4.2) versus 1.7 (1.3-2.1), P < 0.001), as well as parameters of inflammation (CRP 1.8 (0.6-5.8) mg/L versus 0.6 (0.2-1.0) mg/L, P < 0.001) and endothelial activation (VCAM-1 505 (389-683) ng/mL versus 374 (322-427) ng/mL, P < 0.001) and von Willebrand factor (138 (59-208)% versus 48 (24-92)%, P < 0.001), were increased in patients. Vascular remodelling was altered: MMP-3 and TIMP-1 were increased (18 (10-29) ng/mL versus 8 (5-11) ng/mL, P < 0.001, and 275 (216-352) ng/mL versus 230 (197-268) ng/mL, P< 0.001, respectively), and MMP-9 was decreased in SLE (266 (147-412) ng/mL versus 348 (226-530) ng/mL, P < 0.05). Univariate analyses revealed that in patients IMT was associated with age, systolic blood pressure, SCORE and disease duration. In multivariate analysis, age and SCORE were independent predictors of IMT. In conclusion, SLE patients have an increased IMT, which is associated with traditional risk factors. Non-traditional risk factors, such as endothelial activation, altered vascular remodelling and disease duration, might play an additional role.

High-Sensitivity C-Reactive Protein in Systemic Lupus Erythematosus Patients without Cardiac Involvement: Relation to Disease Activity and Intima-Media Thickness

“…This was in accordance with the study of de Leeuw et al, who found CRP significantly higher even in inactive SLE patients [23]. Another study found hs-CRP to be significantly higher in SLE [24] .…”

Rate and determinants of progression of atherosclerosis in systemic lupus erythematosus

“…Older age at diagnosis (3,5,8) and longer disease duration (3,5,8,13,29) have been repeatedly documented to correlate with manifestations of atherosclerosis in SLE. The present study extends the documentation of these characteristics as independent correlates of atherosclerosis progression.…”

“…In view of the importance of inflammation in the genesis and progression of atherosclerosis (11,12), investigators have sought to determine whether specific aspects of SLE, a chronic inflammatory disease, are closely tied to the occurrence of myocardial infarction or the presence of subclinical atherosclerosis. Features of SLE that have been associated with clinical manifestations of coronary artery disease include older age at diagnosis (3,8), longer duration of SLE (3,8,13), higher damage index score (13), longer duration of steroid therapy (1,3,8,14), and higher concentrations of oxidized low-density lipoprotein (LDL) cholesterol and homocysteine (14). Features of SLE associated with the presence of subclinical atherosclerosis include older age at diagnosis (5), longer duration of SLE (5), longer duration of steroid therapy (4), less aggressive immunosuppressive therapy (5), and a higher damage index score (5).…”

Subclinical Atherosclerosis in Systemic Autoimmune Disorders

“…Several studies so far have confirmed the increased prevalence of arterial HT in these patients, ranging from 33% to 56% (de Leeuw, Freire et al 2006;Bellomio, Spindler et al 2009;Duarte, Couto et al 2009;Boucelma, Haddoum et al 2011;Sabio, Vargas-Hitos et al 2011). In an effort to investigate the contributors of HT in a cohort of 112 lupus patients, Sabio et al, reported that renal disease, insulin levels and disease activity indices such as Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) were independent predictors of HT in these subjects.…”