Abstract
Objectives: Patients with systemic lupus erythematosus (SLE) are characterized by increased cardiovascular disease (CVD) risk as well as heightened rates of psychological distress. Since a link between psychological issues and CV morbidity has been previously suggested, the influence of psychological burden on subclinical atherosclerosis in SLE patients was investigated.Methods: 71 SLE patients were assessed for the presence of subclinical atherosclerosis—defined either as carotid and/or femoral plaque formation or arterial wall thickening [Intima Media Thickness (IMT) levels > 0.90 mm by Doppler ultrasound]; personality traits, anxiety and depression, sleeping habits and fatigue levels were also evaluated by specific questionnaires including Eysenck Personality Questionnaire Scale, State-Trait Anxiety Inventory (STAI), Zung Depression Scale, Athens Insomnia Scale and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F). Disease related clinical and laboratory features and traditional risk factors for atherosclerosis were documented. Univariate and multivariate analysis were performed.Results: SLE patients with arterial wall thickening displayed higher STAI anxiety scores (either as a current state or as a personality trait) compared to those without (49.8 ± 5.6 vs. 46.9 ± 5.4, p-value: 0.03 and 49.2 ± 4.4 vs. 45.7 ± 6.8, p-value: 0.009, respectively). In a multivariate model, trait anxiety and extraversion personality scores were found to be independently associated with arterial wall thickening and plaque formation, respectively [OR95%(CI):1.2(1.0–1.5) and 0.7(0.6–1.0), respectively], following adjustment for potential confounders. No other associations were detected.Conclusions: Anxiety and extraversion personality traits have been independently associated with subclinical atherosclerosis in lupus patients, implying psychoneuroimmunological interactions as contributors in SLE related atherosclerosis.
Highlights
Cardiovascular disease (CVD) is a well-established comorbidity of systemic lupus erythematosus (SLE), severely affecting both prognosis and mortality
71 SLE patients were assessed for the presence of subclinical atherosclerosis—defined either as carotid and/or femoral plaque formation or arterial wall thickening [Intima Media Thickness (IMT) levels > 0.90 mm by Doppler ultrasound]; personality traits, anxiety and depression, sleeping habits and fatigue levels were evaluated by specific questionnaires including Eysenck Personality Questionnaire Scale, State-Trait Anxiety Inventory (STAI), Zung Depression Scale, Athens Insomnia Scale and Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F)
Anxiety and extraversion personality traits have been independently associated with subclinical atherosclerosis in lupus patients, implying psychoneuroimmunological interactions as contributors in SLE related atherosclerosis
Summary
Cardiovascular disease (CVD) is a well-established comorbidity of systemic lupus erythematosus (SLE), severely affecting both prognosis and mortality. Traditional CVD risk factors are present or overrepresented in SLE patients. CV risk of an individual based on traditional CV risk factors [1]. These data indicate intrinsic, disease related factors as independent contributors to SLE related atherosclerosis [2]. Depression and anxiety have been long recognized as risk factors to CVD in the general population. Hyperhomocystenemia [7, 8], as well as an imbalance between procoagulant molecules such as fibrinogen or factor VII and impaired fibrinolytic capacity -long implicated in atherogenetic processes- [9] have been shown to occur in the setting of chronic psychosocial stressors [10]. Whether chronic autonomic stimulation results from excess in cigarette smoking, alcohol consumption and lower physical activity remains a possibility [11]
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