Cardiovascular comorbidities and atherosclerosis in systemic lupus erythematosus


Authors: A. Smržová;  P. Horák
Authors‘ workplace: III. interní klinika – nefrologická, revmatologická a endokrinologická ;  Fakultní nemocnice a Univerzita Palackého, Olomouc
Published in: Čes. Revmatol., 25, 2017, No. 3, p. 141-147.
Category: Original article

Overview

The aim of the study was to detect subclinical atherosclerosis by measuring the thickness of intima media and its relation to cardiovascular manifestations, traditional risk factors, clinical manifestations, immunological profile and selected laboratory markers.

Methods:
Patients were screened between March 2015 and January 2016. Forty-two patients with SLE (5 men, 37 women) were examined. Traditional risk factors, clinical manifestations, immunological profile, disease activity and cumulative damage with SELENA-SLEDAI 2K and SLICC scoring systems, cumulative dose of glucocorticoids, disease duration, and presence of cardiovascular events were assessed in these patients. The results were evaluated statistically.

Results:
Pathological IMT was found in 10 patients (23.8%), plaque presence in 7 respondents (13.7%). Subclinical atherosclerosis evaluated by at least one parameter was detected in 14 patients (33%). IMT correlated (p ≤0.05) with the age of patients, age at diagnosis, duration and intensity of smoking, history of ischemic heart disease and stroke, SLICC damage index, low platelet count and C3 complement, and high titer of IgG and IgM anti-cardiolipin antibodies. The presence of plates correlated with age, age at diagnosis, length and intensity of smoking “pack years”, history of ischemic heart disease, SLICC damage index, and low platelet count.

Conclusion:
IMT and plaque detection are very important markers of subclinical atherosclerosis. In our series and in many other studies, these parameters correlate with traditional risk factors and disease activity, and they are a good prognostic factor for the presence of cardiovascular comorbidities..

Key words:
Systemic lupus erythematosus, cardiovascular comorbidities, atherosclerosis, intima media thickness


Sources

1. Zdravotnická ročenka České republiky 2015. http://uzis.cz/node/7693

2. Urowitz MB, Bookman AA, Koehler BE, et al. The bimodal mortality pattern of systemic lupus erythematosus. Am J Med 1976; 60: 221–225.

3. Magder LS, Petri M. Incidence of and risk factors for adverse cardiovascular events among patients with systemic lupus erythematosus. Am J Epidemiol 2012; 176: 708–719.

4. Esdaile JM, Abrahamowicz M, Grodzicky T, et al. Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum 2001; 44: 2331–2337.

5. Shah MA, Shah AM, Krishnan E. Poor outcomes after acute myocardial infarction in systemic lupus erythematosus. J Rheumatol 2009; 36: 570–575.

6. Petri M, Orbai AM, Alarcon 6) GS, et al. Derivation and validation of the Systemic Lupus International Collaborating Clinics classification criteria for systemic lupus erythematosus. Arthritis Rheum 2012; 64: 2677–86.

7. Bombardier C, Gladman DD, Urowitz MB, et al. Derivation of the SLEDAI. A disease activity index for lupus patients. The Committee on Prognosis Studies in SLE. Arthritis Rheum 1992; 35: 630–40.

8. Gladman DD, Goldsmith CH, Urowitz MB, et al. The Systemic Lupus International Collaborating Clinics/American College of Rheuma-tology (SLICC/ACR) Damage Index for Systemic Lupus Erythema-tosus International Comparison. J Rheumatol 2000; 27: 373–276.

9. http://www.diab.cz/dokumenty/standard_labor_2012.pdf

10. Filipovský J, et al. Summary of 2013 ESH/ESC Guidelines for the management of arterial hypertension. Prepared by the Czech Society of Hypertension/Czech Society of Cardiology. Cor et Vasa 2014; 56: e494–e518.

11. https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-13/Intima-media-thickness-Appropriate-evaluation-and-proper-measurement-described

12. Veller MG1, Fisher CM, Nicolaides AN, Renton S, Geroulakos G, Stafford NJ, Sarker A, Szendro G, Belcaro G. Measurement of the ultrasonic intima-media complex thickness in normal subjects. J Vasc Surg 1993; 17(4): 719–25.

13. Pearson TA, Mensah GA, Alexander RW et al. Markers of inflammation and cardiovascular disease: application to clinical and public health practice: A statement for healthcare professionals from the Centres for Disease Control and Prevention and the American Heart Association. Circulation 2003; 107(3): 499–511.

14. Wu GC, Liu HR, Leng RX, Li XP, Li XM, Pan HF, Ye DQ. Subclinical atherosclerosis in patients with systemic lupus erythematosus: A systemic review and meta-analysis. Autoimmun Rev 2016; 15(1): 22–37.

15. Urowitz MB, Gladman D, Ibañez D, et al. Clinical manifestations and coronary artery disease risk factors at diagnosis of systemic lupus erythematosus: data from an international inception cohort. Lupus 2007; 16: 731–5.

16. Kreuter A, Gaifullina R, Tigges C, et al. Lupus erythematosus tumidus: response to antimalarial treatment in 36 patients with emphasis on smoking. Arch Dermatol 2009; 145: 244–8.

17. Kiani AN, Post WS, Magder LS, et al. Predictors of progression in atherosclerosis over 2 years in systemic lupus erythematosus. Rheumatology (Oxford) 2011; 50: 2071–79.

18. Wierzbicki AS. Lipids, cardiovascular disease and atherosclerosis in systemic lupus erythematosus. Lupus 2000; 9(3): 194–201.

19. Petri M, Lakatta C, Magder L, Goldman D. Effect of prednisone and hydroxychloroquine on coronary artery disease risk factors in systemic lupus erythematosus: a longitudinal data analysis. Am J Med 1994; 96(3): 254–9.

20. Urowitz MB et al. Systemic Lupus International Collaborating Clinics. Atherosclerotic vascular events in a multinational inception cohort of systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2010; 62(6): 881–7.

21. Urowitz MB et al. Atherosclerotic vascular events in a single large lupus cohort: Prevalence and risk factors. J Rheumatol 2007; 34: 70–5.

22. Chung CP, Avalos I, Oeser A, et al. High prevalence of the metabolic syndrome in patients with systemic lupus erythematosus: association with disease characteristics and cardiovascular risk factors. Ann Rheum Dis 2007; 66:1542–43.

23. Urowitz MB et al. Systemic Lupus International Collaborating Clinics. Atherosclerotic vascular events in a multinational inception cohort of systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2010; 62(6): 881–7.

24. Toloza SM et al. Systemic lupus erythematosus in a multiethnic US cohort (LUMINA). XXIII. Baseline predictors of vascular events. Arthritis Rheum 2004; 50(12): 3947–57.

25. Smržová A et al. Cardiovascular events in patients with systemic lupus erythematosus, Cor et Vasa 2014; 56: e144–e151.

26. Horák P, Tegzová D, Závada J, Olejárová M, Skácelová M, Smržová A, Žurek M. Doporučení ČRS pro léčbu nemocných se SLE. Čes Revmatol 2013; 21: 3–14.

Labels
Dermatology & STDs Paediatric rheumatology Rheumatology
Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account