Abstract
Accelerated atherosclerosis in systemic lupus erythematosus (SLE) is an important cause of morbidity and mortality. The pathophysiology of accelerated atherosclerosis in SLE is mediated by factors such as inflammatory processes in the vascular wall, specific antibodies, dyslipoproteinemia, endothelial dysfunction and the high prevalence of traditional risk factors for cardiovascular diseases. In this context, we evaluated the clinical significance of ultrasound examination of the carotic arteries in the early diagnosis of atherosclerosis. The study included 63 patients with SLE (female: male 53:10, mean age 38.4±12.7 years, mean disease duration 143.0±82.6 months), 24 patients had lupus nephritis. The control group consisted of 24 volunteers (female: male 20:4 mean age 31.04±8.59). Intima media thickness (IMT) was measured by ultrasound on both sides. The results were correlated with markers of lipid spectrum, anti-dsDNA, antinucleosomal and anticardiolipin antibodies, lupus anticoagulant and complement components. Clinical disease activity and damage were evaluated by SLEDAI and SLICC indices. Lifestyle and other important factors were examined per protocol and by questionnaire. A significant difference of IMT (P≤0.03) was found between the lupus patients and sex-age adjusted healthy controls with an in mean IMT in SLE patients of 0.569±0.11 mm, in control group 0.495±0.05 mm. A significant correlation between IMT and disease duration, age, positivity of lupus anticoagulant, use of ACE inhibitors, glomerular filtration and serum creatinine were found. No difference in IMT was found between patients with or without lupus nephritis. IMT measurement could be used as a clinical predictor of risk of accelerated atherosclerosis in lupus patients.
Highlights
Accelerated atherosclerosis (AT) is one of the major late complications of systemic lupus erythematosus (SLE) and is recognized as a major cause of morbidity and mortality in lupus patients
A study described bimodal “twin-peaks” pattern of mortality rate related to SLE, the first peak being associated with active lupus, the second with acute myocardial infarction or other cardiovascular diseases[10,11,12,13,14,15] years after initial diagnosis[2]
The characteristic of SLE group and prevalence of cardiovascular risk factors is summarized in the Table 1, which summarizes the correlation of these parameters with Intima media thickness (IMT)
Summary
Accelerated atherosclerosis (AT) is one of the major late complications of systemic lupus erythematosus (SLE) and is recognized as a major cause of morbidity and mortality in lupus patients. A study described bimodal “twin-peaks” pattern of mortality rate related to SLE, the first peak being associated with active lupus, the second with acute myocardial infarction or other cardiovascular diseases[10,11,12,13,14,15] years after initial diagnosis[2]. Patients with SLE have more than six times higher risk of AT than the general population[4]. In studies, this relative risk ranges from 5.0-10.0 depending on the design of the observation and the odds ratio lays between 4.8 and 9.8 (ref.[4,5]). The data from the General Practice Research Database in the UK showed 2.67 times more common acute myocardial infarction in SLE patients than in controls[7]. The vast majority of these publications show that higher prevalence of traditional risk factor cannot be the only explanation for these alarming findings and that the complex inflammatory character of SLE with numerous consequences plays a crucial role[9]
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