Cardiovascular events in patients with systemic lupus erythematosus

Abstract

IntroductionCardiovascular involvement represents the leading cause of mortality in SLE patients. Its most common manifestations include pericarditis, valvular affections, conduction disorders, and arterial hypertension. Pulmonary hypertension and coronary arteritis are seen less often. Venous thrombosis directly related to SLE affects about 10% of SLE cases. Acceleration of atherosclerosis is very important and so are the ensuing cardiocerebral events, the most common of these being myocardial infarctions (MIs), cerebrovascular events, thromboembolic events (TEs), heart failure, and sudden death. We analyzed the frequency of cardiovascular events and their relationship to selected risk factors in a cohort of SLE patients followed in a single clinical center. MethodsThe studied population comprised 63 SLE patients (women: men=53: 10, mean age 38.4±12.7 years, mean disease duration 143±82 months, BMI 24.74±5.06, waist circumference 83.38±16.58cm), including 25 patients with lupus nephritis. Intima-media thickness (IMT) was assessed ultrasonographically in a standard manner. Of laboratory values, serum concentrations of total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), anti-ds-DNA, antinucleosomal antibodies (ANUC), complement components C3 and C4, and ENA antibodies were measured. Clinical disease activity was assessed using indices of activity and cumulative damage such as SLEDAI and SLICC. Screening for traditional cardiovascular risk factors was based on appropriate questionnaires. Detailed analysis was employed to calculate cumulative doses of glucocorticoids and other immunosuppressants and to evaluate the use of anticoagulants, antiaggregants, statins, and ACE inhibitors. ResultsA total of 21 (33%) patients had a history of cardiovascular event during the course of their SLE: there were 3 myocardial infarctions (4.7% of the entire population, 14% of all cardiovascular events), 8 cerebrovascular events (12.7%, resp. 38%), and 12 thromboembolic events (19%, resp. 57%). In two patients, two different manifestations of cardiovascular involvement were combined – cerebrovascular event and MI in one, cerebrovascular event and TE event in the other. Cardiovascular events correlated with obesity, waist and hip circumference, smoking, total cholesterol, LDL, TC/HDL ratio, and apolipoproteins A-1 and B.Borderline statistical significance was noted for disease activity, hsCRP, positivity of RNP and anticardiolipin antibodies, lupus anticoagulant (p=0.06) and intima-media thickness (p=0.07). Subgroups of patients with cardiovascular event and arterial hypertension were also analyzed in more detail. ConclusionIn this article, we point to the high rate of cardiovascular events in SLE patients, thus confirming the need to pay appropriate attention to cardiovascular problems in the field of rheumatology.