1
|
Lai ECC, Huang YC, Liao TC, Weng MY. Premature coronary artery disease in patients with immune-mediated inflammatory disease: a population-based study. RMD Open 2022; 8:rmdopen-2021-001993. [PMID: 35064093 PMCID: PMC8785203 DOI: 10.1136/rmdopen-2021-001993] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/23/2021] [Indexed: 12/22/2022] Open
Abstract
Background The associations between premature atherosclerosis and immune-mediated inflammatory diseases (IMIDs) are not fully investigated. To determine whether IMIDs are associated with premature atherosclerosis, we examined the risk of incident coronary artery disease (CAD) in men less than 45 years old and women less than 50 years old with various forms of IMIDs compared with general population. Methods A population-based cohort was established and included patients with IMID, who were followed until the development of CAD, withdrawal from the insurance system, death, or 31 December 2016, whichever point came first. Patients with IMID included rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), primary Sjogren’s syndrome (SjS), idiopathic inflammatory myositis, systemic sclerosis (SSc), Behcet’s disease (BD), and systemic vasculitis (SV). The comparison group was 1 000 000 beneficiaries sampled at random from the whole population as matched control participants. The Kaplan-Meier method was used to compare the cumulative incidences of CAD in patients with and without IMID. Results Among 58 862 patients with IMID, 2139 (3.6%) developed CAD and 346 (1.3%) developed premature CAD. Relative to the comparison cohorts, the adjusted HRs for premature CAD were 1.43 (95% CI 1.09 to 1.86) for primary SjS, 2.85 (95% CI 2.63 to 3.43) for SLE, 3.18 (95% CI 1.99 to 5.09) for SSc and 2.27 (95% CI 1.01 to 5.07) for SV. Conclusions Primary Sjogren’s syndrome, SLE, SSc and SV are associated with an increased risk of premature CAD. Our findings will support essential efforts to improve awareness of IMID impacting young adults.
Collapse
Affiliation(s)
- Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ya-Chun Huang
- Department of Internal Medicine, Division of Allergy, Immunology, and Rheumatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Chi Liao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Meng-Yu Weng
- Department of Internal Medicine, Division of Allergy, Immunology, and Rheumatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
2
|
Wirestam L, Saleh M, Svensson C, Compagno M, Zachrisson H, Wetterö J, Sjöwall C. Plasma osteopontin versus intima media thickness of the common carotid arteries in well-characterised patients with systemic lupus erythematosus. Lupus 2021; 30:1244-1253. [PMID: 33957796 PMCID: PMC8209759 DOI: 10.1177/09612033211013898] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective The progress of accelerated atherosclerosis in systemic lupus erythematosus (SLE) is incompletely understood. Circulating osteopontin (OPN) is increased in autoimmune conditions, e.g. SLE, and its serum concentration was recently reported to associate with subclinical atherosclerosis in SLE, as measured by carotid intima-media thickness. The aim of this study was to investigate whether OPN may be used as a surrogate biomarker of subclinical atherosclerosis in SLE patients with different disease phenotypes. Methods We recruited 60 well-characterised SLE cases and 60 age- and sex-matched healthy controls. The SLE cases were divided into three different disease phenotypes: SLE with antiphospholipid syndrome (APS), lupus nephritis, and isolated skin and joint involvement. Plasma OPN was detected by ELISA (Quantikine®, R&D Systems). Common carotid arteries intima media thickness was compared between the studied groups in relation to OPN levels and risk factors for vascular changes. Intima media thickness of common carotid arteries was measured by using a sensitive ultrasound technique (LOGIQ™ E9 ultrasound, GE Healthcare). Results OPN levels were significantly higher among the entire SLE group (n = 60) compared to the healthy controls (P = 0.03). SLE cases with concomitant APS (n = 20) showed higher OPN levels than the controls (P = 0.004), whereas none of the other two subgroups differed significantly from the healthy controls. OPN and intima media thickness were correlated to several traditional risk factors of atherosclerosis, as well as to SLE-related factors. Yet, no significant correlation was observed between OPN levels and ultrasound findings of the common carotid arteries. Conclusions In line with previous studies, we observed increased OPN levels among SLE patients as compared to matched controls. However, the OPN concentrations did not correlate with intima media thickness of the common carotid arteries. Based on our findings, the use of OPN as a surrogate biomarker of subclinical atherosclerosis in SLE subjects, regardless of clinical phenotypes, cannot be recommended.
Collapse
Affiliation(s)
- Lina Wirestam
- Division of Inflammation and Infection/Rheumatology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Muna Saleh
- Division of Inflammation and Infection/Rheumatology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Christina Svensson
- Department of Clinical Physiology, University Hospital and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Michele Compagno
- Department of Clinical Sciences Lund, Rheumatology, Lund University, Lund, Sweden
| | - Helene Zachrisson
- Department of Clinical Physiology, University Hospital and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jonas Wetterö
- Division of Inflammation and Infection/Rheumatology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Christopher Sjöwall
- Division of Inflammation and Infection/Rheumatology, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
3
|
McVeigh ED, Batool A, Stromberg A, Abdel-Latif A, Kazzaz NM. Cardiovascular complications of systemic lupus erythematosus: impact of risk factors and therapeutic efficacy-a tertiary centre experience in an Appalachian state. Lupus Sci Med 2021; 8:e000467. [PMID: 33952624 PMCID: PMC8103370 DOI: 10.1136/lupus-2020-000467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/05/2021] [Accepted: 04/16/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Cardiovascular complications became a notable cause of morbidity and mortality in patients with lupus as therapeutic advancements became more efficient at managing other complications. The Appalachian community in Kentucky has a higher prevalence of traditional cardiovascular risk factors, predisposing them to cardiovascular events. Namely, the mean body mass index of the members of the Kentucky Appalachian community was reported at 33 kg/m2 and 94.3% of male members of this community use tobacco. We sought to identify risk factors that predispose patients with lupus to cardiovascular morbidities and examine the effect of immunomodulatory drugs. METHODS We identified 20 UKHS patients having both a lupus diagnosis and experienced at least one cardiovascular event. We chose three controls matched for birth-year ±5 years to each case. In a case-control design, we analysed lupus manifestations, cardiovascular risk factors and immunosuppressive therapies. We collected Systemic Lupus Erythematosus Disease Activity Index 2000 disease activity index during the cardiovascular event. RESULTS We identified 308 patients with lupus from among all University of Kentucky Health System patients. 20 (6.5%) of such patients with lupus were confirmed to cardiovascular complication. Of those 20, 7 (35%) had experienced myocardial infarction, 10 (50%) had experienced stroke and 4 (20%) had peripheral ischaemia. Tobacco use and male gender were the only traditional cardiovascular risk factors higher in the cases group. Hydroxychloroquine and steroids were less utilised in the cases than in the controls (70% vs 100% in hydroxychloroquine, 30% vs 82% in steroids). Venous thrombosis was found to be significantly higher in the cases. On multivariate analysis, venous thrombosis remained significant. CONCLUSION Despite tobacco use partially explaining the increased risk of cardiovascular disease among the cases group, the higher prevalence of venous thrombosis in the cases group suggests lupus as a potential additional risk factor of cardiovascular morbidity among patients with lupus in this Appalachian community.
Collapse
Affiliation(s)
- Elise Danielle McVeigh
- Internal Medicine Department, Division of Rheumatology, University of Kentucky, Lexington, Kentucky, USA
| | - Amna Batool
- Internal Medicine Department, Division of Rheumatology, University of Kentucky, Lexington, Kentucky, USA
| | - Arnold Stromberg
- Department of Statistics, University of Kentucky, Lexington, Kentucky, USA
| | - Ahmed Abdel-Latif
- Internal Medicine, Division of Cardiology, University of Kentucky, Lexington, Kentucky, USA
| | - Nayef Mohammed Kazzaz
- Internal Medicine Department, Division of Rheumatology, University of Kentucky, Lexington, Kentucky, USA
| |
Collapse
|
4
|
Chew C, Reynolds JA, Lertratanakul A, Wu P, Urowitz M, Gladman DD, Fortin PR, Bae SC, Gordon C, Clarke AE, Bernatsky S, Hanly JG, Isenberg D, Rahman A, Sanchez-Guerrero J, Romero-Diaz J, Merrill J, Wallace D, Ginzler E, Khamashta M, Nived O, Jönsen A, Steinsson K, Manzi S, Kalunian K, Dooley MA, Petri M, Aranow C, van Vollenhoven R, Stoll T, Alarcón GS, Lim SS, Ruiz-Irastorza G, Peschken CA, Askanase AD, Kamen DL, İnanç M, Ramsey-Goldman R, Bruce IN. Lower vitamin D is associated with metabolic syndrome and insulin resistance in systemic lupus: data from an international inception cohort. Rheumatology (Oxford) 2021; 60:4737-4747. [PMID: 33555325 DOI: 10.1093/rheumatology/keab090] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/07/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Vitamin D (25(OH)D) deficiency and metabolic syndrome (MetS) may both contribute to increased cardiovascular risk in systemic lupus erythematosus (SLE). We aimed to examine the association of demographic factors, SLE phenotype, therapy and vitamin D levels with MetS and insulin resistance. METHODS The Systemic Lupus International Collaborating Clinics (SLICC) enrolled patients recently diagnosed with SLE (<15 months) from 33 centres across 11 countries from 2000. Clinical, laboratory and therapeutic data were collected. Vitamin D level was defined according to tertiles based on distribution across this cohort, which were set at T1 (10-36 nmol/l), T2 (37-60 nmol/l) and T3 (61-174 nmol/l). MetS was defined according to the 2009 consensus statement from the International Diabetes Federation. Insulin resistance was determined using the HOMA-IR model. Linear and logistic regressions were used to assess the association of variables with vitamin D levels. RESULTS Of the 1847 patients, 1163 (63%) had vitamin D measured and 398 (34.2%) subjects were in the lowest 25(OH)D tertile. MetS was present in 286 of 860 (33%) patients whose status could be determined. Patients with lower 25(OH)D were more likely to have MetS and higher HOMA-IR. The MetS components, hypertension, hypertriglyceridemia and decreased HDL were all significantly associated with lower 25(OH)D. Increased average glucocorticoid exposure was associated with higher insulin resistance. CONCLUSIONS MetS and insulin resistance are associated with lower vitamin D in patients with SLE. Further studies could determine whether vitamin D repletion confers better control of these cardiovascular risk factors and improve long-term outcomes in SLE.
Collapse
Affiliation(s)
- Christine Chew
- Lydia Becker Institute of Immunology and Inflammation, Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - John A Reynolds
- Sandwell and West Birmingham NHS Trust, Birmingham, UK.,Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Peggy Wu
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Murray Urowitz
- Toronto Western Hospital Centre for Prognosis Studies in the Rheumatic Diseases Toronto, ON, CAN
| | - Dafna D Gladman
- Toronto Western Hospital Centre for Prognosis Studies in the Rheumatic Diseases Toronto, ON, CAN
| | - Paul R Fortin
- Department of Rheumatology, Université Laval Faculté de médecine, Quebec, QC, CAN
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seongdong-gu, Seoul, KR
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Ann E Clarke
- Divisions of Clinical Immunology/Allergy and Clinical Epidemiology, University of Calgary Cumming School of Medicine, Calgary, AB, CAN
| | - Sasha Bernatsky
- Faculty of Medicine, Division of Rheumatology, McGill University, Montreal, QC, CAN
| | - John G Hanly
- Queen Elizabeth II Health Sciences Centre, Division of Rheumatology, Department of Medicine and Department of Pathology Halifax, NS, CAN
| | - David Isenberg
- Faculty of Medical Sciences, Division of Medicine, University College London, London, London, UK
| | - Anisur Rahman
- Faculty of Medical Sciences, Division of Medicine, University College London, London, London, UK
| | - Jorge Sanchez-Guerrero
- Toronto Western Hospital Centre for Prognosis Studies in the Rheumatic Diseases Toronto, ON, CAN
| | - Juanita Romero-Diaz
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Immunology and Rheumatology Tlalpan, DF, MX
| | - Joan Merrill
- Department of Clinical Pharmacology, Oklahoma Medical Research Foundation Arthritis and Clinical Immunology Research Program, Oklahoma City, OK, USA
| | | | - Ellen Ginzler
- Department of Medicine, SUNY Downstate Medical Center College of Medicine, Brooklyn, NY, USA
| | - Munther Khamashta
- Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, London, UK
| | - Ola Nived
- Faculty of Medicine, Department of Clinical Sciences Lund, Section of Rheumatology, Lunds University, Lund, SE
| | - Andreas Jönsen
- Faculty of Medicine, Department of Clinical Sciences Lund, Section of Rheumatology, Lunds University, Lund, SE
| | - Kristjan Steinsson
- Department of Rheumatology, National University Hospital of Iceland, Reykjavik, Capital, IS
| | - Susan Manzi
- Allegheny Health Network, Lupus Center of Excellence, Pittsburgh, PA, USA
| | - Ken Kalunian
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Mary Anne Dooley
- University of North Carolina at Chapel Hill, Division of Rheumatology and Immunology, Department of Medicine, Chapel Hill, NC, USA
| | - Michelle Petri
- Department of Rheumatology, Johns Hopkins University School of Medicine Center for Musculoskeletal Research, Baltimore, MD, USA
| | - Cynthia Aranow
- Northwell Health Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Thomas Stoll
- Department of Rheumatology, Kantonsspital Schaffhausen, Schaffhausen, Schaffhausen, CH
| | - Graciela S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - S Sam Lim
- Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Guillermo Ruiz-Irastorza
- Hospital Universitario Cruces, Autoimmune Diseases Units, Biocruces Bizkaia Health Research Institute, Barakaldo, País Vasco, ES
| | | | - Anca D Askanase
- Columbia University Irving Medical Center, New York, NY, USA
| | - Diane L Kamen
- Columbia University Irving Medical Center, New York, NY, USA
| | - Murat İnanç
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul University Istanbul, Istanbul, Istanbul, TR
| | | | - Ian N Bruce
- Manchester University NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, Greater Manchester, UK.,Versus Arthritis Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, UK
| |
Collapse
|
5
|
Systemic Lupus Erythematosus, Its Impact on Selected Cardiovascular Risk Factors, and Correlation with Duration of Illness: A Pilot Study. Cardiol Res Pract 2020; 2020:7025329. [PMID: 33204527 PMCID: PMC7665909 DOI: 10.1155/2020/7025329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/20/2020] [Accepted: 10/20/2020] [Indexed: 12/22/2022] Open
Abstract
Systemic lupus erythematosus is a rare autoimmune disease. It leads to an increased production of proinflammatory molecules that accelerates atherogenesis and could cause an endothelium dysfunction. The aim of the study was to assess cardiovascular risk factors such as BMI and lipid profile as well as left ventricular ejection fraction among patients with SLE, and a correlation of these factors with duration of the disease. Materials and Methods. The researched group consisted of patients with SLE, being under control of the outpatient clinic of cardiology. This group included 38 patients among whom 34 were women (56.17 ± 11.05 years) and 4 were men (65.50 ± 9.22 years). The control group consisted of 19 healthy women (53.31 ± 11.94 years) and 2 healthy men (38.51 ± 7.53 years). Measurements were taken in the same conditions by trained medical staff. Results. Excessive body weight (BMI >25 kg/m2) was more frequent in the SLE group, but it was not statistically significant (55.26% vs. 52.38%, p = 0.6159). LVEF values were lower in their searched group, and this factor showed statistical significance (53.92% ± 6.46 vs. 58.67% ± 4.69, p = 0.0044). Thickness of the IMT was higher and statistically important among patients with SLE, both in left (1.22 ± 0.27 mm vs. 0.7 ± 0.21 mm, p = 0.0001) and right common carotid artery (1.16 ± 0.26 mm vs. 0.59 ± 0.15 mm, p = 0.0001), compared to the controls. Conclusions. Patients with SLE are at greater risk of developing cardiovascular diseases as the illness progresses. The activity of the disease according to the SLEDAI-2K scale may have an impact on the LVEF values which was significantly decreased in the group with active disease, but further thorough investigation is required to fully evaluate the impact of individual components of the disease and its treatment on the CVD development and mortality.
Collapse
|
6
|
Urowitz MB, Gladman DD, Farewell V, Su J, Romero-Diaz J, Bae SC, Fortin PR, Sanchez-Guerrero J, Clarke AE, Bernatsky S, Gordon C, Hanly JG, Wallace DJ, Isenberg DA, Rahman A, Merrill JT, Ginzler E, Alarcón GS, Chatham WW, Petri MA, Bruce IN, Khamashta MA, Aranow C, Dooley MA, Manzi S, Ramsey-Goldman R, Nived O, Jönsen A, Steinsson K, Zoma AA, Ruiz-Irastorza G, Lim SS, Kalunian KC, Ỉnanç M, van Vollenhoven R, Ramos-Casals M, Kamen DL, Jacobsen S, Peschken CA, Askanase A, Stoll T. Accrual of Atherosclerotic Vascular Events in a Multicenter Inception Systemic Lupus Erythematosus Cohort. Arthritis Rheumatol 2020; 72:1734-1740. [PMID: 32515554 DOI: 10.1002/art.41392] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Accepted: 05/13/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE In previous studies, atherosclerotic vascular events (AVEs) were shown to occur in ~10% of patients with systemic lupus erythematosus (SLE). We undertook this study to investigate the annual occurrence and potential risk factors for AVEs in a multinational, multiethnic inception cohort of patients with SLE. METHODS A large 33-center cohort of SLE patients was followed up yearly between 1999 and 2017. AVEs were attributed to atherosclerosis based on SLE being inactive at the time of the AVE as well as typical atherosclerotic changes observed on imaging or pathology reports and/or evidence of atherosclerosis elsewhere. Analyses included descriptive statistics, rate of AVEs per 1,000 patient-years, and univariable and multivariable relative risk regression models. RESULTS Of the 1,848 patients enrolled in the cohort, 1,710 had ≥1 follow-up visit after enrollment, for a total of 13,666 patient-years. Of these 1,710 patients, 3.6% had ≥1 AVEs attributed to atherosclerosis, for an event rate of 4.6 per 1,000 patient-years. In multivariable analyses, lower AVE rates were associated with antimalarial treatment (hazard ratio [HR] 0.54 [95% confidence interval (95% CI) 0.32-0.91]), while higher AVE rates were associated with any prior vascular event (HR 4.00 [95% CI 1.55-10.30]) and a body mass index of >40 kg/m2 (HR 2.74 [95% CI 1.04-7.18]). A prior AVE increased the risk of subsequent AVEs (HR 5.42 [95% CI 3.17-9.27], P < 0.001). CONCLUSION The prevalence of AVEs and the rate of AVE accrual demonstrated in the present study is much lower than that seen in previously published data. This may be related to better control of both the disease activity and classic risk factors.
Collapse
Affiliation(s)
- Murray B Urowitz
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Dafna D Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Vernon Farewell
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Jiandong Su
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, and University of Toronto, Toronto, Ontario, Canada
| | | | - Sang-Cheol Bae
- Hanyang University Hospital for Rheumatic Diseases, Seoul, Republic of Korea
| | - Paul R Fortin
- Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Quebec, Canada
| | - Jorge Sanchez-Guerrero
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Ann Elaine Clarke
- University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Sasha Bernatsky
- Montreal General Hospital and McGill University Health Centre, Montreal, Quebec, Canada
| | - Caroline Gordon
- University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - John G Hanly
- Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Daniel J Wallace
- Cedars-Sinai Medical Center, David Geffen School of Medicine, University of California, Los Angeles
| | | | | | | | | | | | | | - Michelle A Petri
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ian N Bruce
- Arthritis Research UK Centre for Epidemiology, Manchester Academic Health Sciences Centre, The University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Munther A Khamashta
- St Thomas' Hospital and King's College London School of Medicine, London, UK
| | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York
| | | | - Susan Manzi
- Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania
| | | | - Ola Nived
- Lund University and Skåne University Hospital, Lund, Sweden
| | - Andreas Jönsen
- Lund University and Skåne University Hospital, Lund, Sweden
| | - Kristján Steinsson
- Fossvogur Landspitali University Hospital Center for Rheumatology Research, Reykjavik, Iceland
| | - Asad A Zoma
- Hairmyres Hospital, East Kilbride, Scotland, UK
| | | | - S Sam Lim
- Emory University School of Medicine, Atlanta, Georgia
| | | | - Murat Ỉnanç
- Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | | | - Manuel Ramos-Casals
- Institut d'Investigacions Biomèdiques August Pi i Sunyer and Hospital Clínic, Barcelona, Spain
| | | | - Soren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic and Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Anca Askanase
- Hospital for Joint Diseases, New York University, New York, New York
| | | |
Collapse
|
7
|
Atta AM, Silva JPCG, Santiago MB, Oliveira IS, Oliveira RC, Sousa Atta MLB. Clinical and laboratory aspects of dyslipidemia in Brazilian women with systemic lupus erythematosus. Clin Rheumatol 2018. [DOI: 10.1007/s10067-018-4051-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
|
8
|
Mak A, Kow NY, Schwarz H, Gong L, Tay SH, Ling LH. Endothelial dysfunction in systemic lupus erythematosus - a case-control study and an updated meta-analysis and meta-regression. Sci Rep 2017; 7:7320. [PMID: 28779080 PMCID: PMC5544707 DOI: 10.1038/s41598-017-07574-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 06/29/2017] [Indexed: 01/28/2023] Open
Abstract
Endothelium-dependent flow-mediated dilation (ED-FMD), a biophysical marker of endothelial dysfunction, is apparently impaired in patients with systemic lupus erythematosus (SLE) but such observation is inconsistent. Here, we assessed and compared the brachial artery ED-FMD (baED-FMD) using ultrasonography between SLE patients without cardiovascular disease and healthy controls (HC) matched for age, gender and body mass index. We then performed a comprehensive meta-analysis of case-control studies which compared baED-FMD between SLE patients and HC by determining the effect size of baED-FMD as standardized mean difference (SMD). Factors associated with the effect size were explored by mixed-model meta-regression. Seventy one SLE patients and 71 HC were studied. SLE patients had lower baED-FMD than HC (3.72 ± 2.8% vs 4.63 ± 3.1%, p = 0.032). Meta-analysis of 25 case-control studies involving 1,313 SLE patients and 1,012 HC with the random effects model revealed lower baED-FMD in SLE patients compared to HC (SMD −1.077, p < 0.001). The presence of diabetes mellitus (p = 0.04747), higher diastolic blood pressure (p = 0.044), renal involvement (p = 0.027) and aspirin use (p = 0.001) were associated with more discrepant baED-FMD between both groups. In conclusion, SLE patients naïve of cardiovascular disease have impaired endothelial function. Diabetes mellitus, renal disease and diastolic hypertension are major contributors of endothelial dysfunction in SLE patients.
Collapse
Affiliation(s)
- Anselm Mak
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,University Medicine Cluster, National University Heart Centre, Singapore, Singapore.
| | - Nien Yee Kow
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Herbert Schwarz
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lingli Gong
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sen Hee Tay
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,University Medicine Cluster, National University Heart Centre, Singapore, Singapore
| | - Lieng Hsi Ling
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Department of Cardiology, National University Heart Centre, Singapore, Singapore
| |
Collapse
|
9
|
Ali Abdalla M, Mostafa El Desouky S, Sayed Ahmed A. Clinical significance of lipid profile in systemic lupus erythematosus patients: Relation to disease activity and therapeutic potential of drugs. EGYPTIAN RHEUMATOLOGIST 2017. [DOI: 10.1016/j.ejr.2016.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
10
|
Johnson SR, Harvey PJ, Floras JS, Iwanochko M, Ibanez D, Gladman DD, Urowitz M. Impaired brachial artery endothelium dependent flow mediated dilation in systemic lupus erythematosus: preliminary observations. Lupus 2016; 13:590-3. [PMID: 15462488 DOI: 10.1191/0961203304lu1072oa] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Our objective was to compare brachial artery endothelium dependent and independent vasodilation in lupus patients and healthy females, by means of high-resolution noninvasive brachial artery ultrasound. Endothelially mediated vasodilation was estimated noninvasively by examination of brachial artery responses to postischemic reactive hyperemia and endothelial independent vasodilation from response to sublingual glycerlynitrate (GTN) using high-resolution external vascular ultrasound. Five patients with known coronary artery disease (CAD), five with subclinical CAD, five with no CAD and five control subjects were assessed. Endothelium dependent vasodilation was significantly blunted in lupus patients with CAD as compared with healthy female controls (0.11 versus 11.1%, P 1/4 0.018). Corresponding values for lupus patients with subclinical CAD and no CAD were 11 and 9.6%, respectively. For each subject, endothelium dependent vasodilation (EDV) was related to endothelium independent vasodilation (EIV) to adjust for varying vascular smooth muscle responses to GTN in individual subjects. This ratio was markedly depressed in lupus patients with CAD as compared with control subjects (0.12 versus 1.15). The corresponding EDV/EIV ratios for patients with subclinical CAD and no CAD were similar at 0.69 and 0.65, respectively. The conclusion was that flow mediated vasodilation in lupus patients with coronary artery disease is markedly depressed as compared to healthy subjects.
Collapse
Affiliation(s)
- S R Johnson
- Department of Medicine, University of Toronto, Toroto, Ontario, Canada
| | | | | | | | | | | | | |
Collapse
|
11
|
Martinez-Berriotxoa A, Ruiz-Irastorza G, Egurbide MV, Garmendia M, Gabriel Erdozain J, Villar I, Aguirre C. Transiently positive anticardiolipin antibodies and risk of thrombosis in patients with systemic lupus erythematosus. Lupus 2016; 16:810-6. [PMID: 17895304 DOI: 10.1177/0961203307083316] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Fluctuations in the titers of anticardiolipin antibodies (aCL) have been reported in systemic lupus erythematosus (SLE) patients, but their relation with thrombosis is not completely understood. Prospective inception cohort of 237 patients with SLE (American College of Rheumatology criteria). Positivity for antiphospholipid antibodies (aPL) was defined according to Sapporo criteria. aCL was defined as persistently positive when more than two-thirds of the determinations were positive during follow-up. Patients were classified into four groups: A [positive lupus anticoagulant (LA)], B (negative LA and persistently positive aCL), C (negative LA and transiently positive aCL) and D (negative LA and aCL). Of these 237 patients, 211 (89%) patients were women. Median age at diagnosis and follow-up were 32 (2—78) and 10 (1—31) years, respectively; 33 (13.9%), 23 (9.7%), 42 (17.7%) and 139 (58.6%) patients were classified in groups A, B, C and D, respectively. Thirty (12.6%) and 23 (9.7%) patients suffered arterial and venous thrombotic events, respectively. Adjusted risk for arterial thrombosis was increased in groups A [odds ratio (OR) 15.69, 95% confidential interval (CI) 4.79—51.42, P < 0.001] and B (OR 7.63, 95% CI 2.00—29.08, P = 0.003), but not in group C when compared with group D. Adjusted risk of venous thrombosis was increased in group A (OR 4.24, 95% CI 1.36—13.20, P = 0.013), but not in groups B or C when compared with group D. Risk of thrombosis is not increased in SLE patients with negative LA and transiently positive aCL, even fulfilling Sapporo laboratory criteria, when compared with aPL-negative SLE patients. Lupus (2007) 16, 810—816.
Collapse
Affiliation(s)
- Agustin Martinez-Berriotxoa
- Service of Internal Medicine, Hospital de Cruces, Universidad Del Pais Vasco/Euskal Herriko Unibertsitatea, Bizkaia, The Basque Country, Spain.
| | | | | | | | | | | | | |
Collapse
|
12
|
Bjarnegråd N, Bengtsson C, Brodszki J, Sturfelt G, Nived O, Länne T. Increased aortic pulse wave velocity in middle aged women with systemic lupus erythematosus. Lupus 2016; 15:644-50. [PMID: 17120590 DOI: 10.1177/0961203306071402] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Systemic lupus erythematosus (SLE) is a connective tissue disease where inflammatory activity affects several organ systems. An increased risk of cardiovascular disease has been identified in these patients, even after correction for traditional risk factors. The aim of the present study was to evaluate arterial stiffness and central hemodynamics in women with SLE in comparison to controls. Arterial tonometry was used to measure aortic (carotid-femoral) and arm (carotid-radial) pulse wave velocity (PWV), reflected pressure waves, and aortic augmentation index (AIx) in 27 women with SLE (52 to 68 years) and 27 controls. Aortic PWV was higher in women with SLE than controls, 9.8 m/s versus 8.2 m/s ( P 0.01), after correction for mean arterial pressure and body mass index, 9.5 m/s versus 8.5 m/s ( P 0.05). Other parameters were similar, arm PWV, 8.4 versus 8.5 m/s, AIx 34 versus 33% and calculated central aortic pulse pressure 48 versus 43 mmHg, in SLE and controls, respectively (NS). Aortic PWV was positively associated to C-reactive protein (CRP) and complement factor 3 (C3). Women with SLE have increased stiffness of their elastic central arteries. This may be one factor contributing to the increased cardiovascular risk seen in this cohort.
Collapse
Affiliation(s)
- N Bjarnegråd
- Department of Medicine and Care, University of Linköping, Jonköping Hospital, Sweden.
| | | | | | | | | | | |
Collapse
|
13
|
Ruiz-Irastorza G, Egurbide MV, Pijoan JI, Garmendia M, Villar I, Martinez-Berriotxoa A, Erdozain JG, Aguirre C. Effect of antimalarials on thrombosis and survival in patients with systemic lupus erythematosus. Lupus 2016; 15:577-83. [PMID: 17080912 DOI: 10.1177/0961203306071872] [Citation(s) in RCA: 279] [Impact Index Per Article: 34.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Antimalarials have shown beneficial effects on systemic lupus erythematosus (SLE) activity. Our aim was to investigate whether antimalarials protect against thrombosis and influence survival in SLE patients. A prospective cohort including 232 patients with SLE were included in the study at the time of lupus diagnosis. End points were documented thrombosis and death due to any cause. A Cox regression-multiple-failure time survival analysis model was fitted to establish the effect of antimalarials on the development of thrombosis. Kaplan-Meier survival curves and propensity score adjusted-Cox regression analysis were performed to investigate the effect of antimalarials use on survival. Of our subjects, 204 patients (88%) were women. 230 patients (99%) were white. 150 patients (64%) had ever received antimalarials. Median time on antimalarials was 52 months (range three to 228 months). The Cox multiple-failure time survival analysis showed that taking antimalarials was protective against thrombosis (HR 0.28, 95%CI 0.08-0.90), while aPL-positivity (HR 3.16, 95%CI 1.45-6.88) and previous thrombosis (HR 3.85, 95%CI 1.50-9.91) increased the risk of thrombotic events. Twenty-three patients died, 19 of whom (83%) had never received antimalarials. No patient treated with antimalarials died of cardiovascular complications. Cumulative 15-year survival rates were 0.68 for never versus 0.95 for ever treated patients ( P < 0.001). Age at diagnosis and propensity score-adjusted HR for antimalarials ever versus never users was 0.14 (95%CI 0.04-0.48). Our study shows a protective effect of antimalarials against thrombosis and an increased survival of SLE patients taking these drugs. These data support the routine use of antimalarials in all patients with SLE.
Collapse
Affiliation(s)
- G Ruiz-Irastorza
- Department of Internal Medicine, Hospital de Cruces, University of the Basque Country, Bizkaia, Spain.
| | | | | | | | | | | | | | | |
Collapse
|
14
|
|
15
|
Martínez-Berriotxoa A, Ruiz-Irastorza G, Egurbide MV, Rueda M, Aguirre C. Homocysteine, antiphospholipid antibodies and risk of thrombosis in patients with systemic lupus erythematosus. Lupus 2016; 13:927-33. [PMID: 15645748 DOI: 10.1191/0961203304lu2035oa] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Cardiovascular disease is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Antiphospholipid syndrome (APS) is one of the most important causes of thrombosis in SLE. In addition, an association between hyperhomocysteinemia and increased cardiovascular risk has also been reported. Our aim is to analyse the association of thrombosis with plasma total homocysteine (ptHcy), antiphospholipid antibodies (aPL) and other vascular risk factors in SLE patients. Fasting plasma levels of ptHcy, vitamin B12, folate, total cholesterol and creatinine were measured in 117 SLE patients. Clinical and immunological data were obtained from our prospective computerized database. aPL-positivity was defined according to Sapporo criteria. There was no association between aPL and ptHcy. ptHcy was higher in patients with arterial (median 13.02 versus 10.16 mmol/L, P = 0.010) but not venous thrombosis. In the subgroup analysis, this association was only seen in aPL-negative patients. In logistic regression, aPL (OR 6.60, 95% CI 1.86-23.34) and ptHcy (OR 1.10, 95% CI 1.01-1.19) were independently associated with arterial thrombosis. However, when hypertension, smoking and plasma total cholesterol were added to the model, only aPL (OR 7.38, 95% CI 2.02-26.91) and hypertension (OR 7.70, 95% CI 2.33-25.39), but not ptHcy, remained independently related to arterial events. aPL was the only variable independently related to venous thrombosis (OR 7.68, 95% CI 1.60-36.86). ptHcy concentrations are higher in SLE patients with arterial thrombosis. No interaction between homocysteine and aPL was found. Raised ptHcy may be a marker of increased vascular risk in aPL-negative SLE patients. The role of homocysteine as a marker of vascular risk may depend on the presence of traditional risk factors, although a modest intrinsic effect cannot be entirely excluded.
Collapse
Affiliation(s)
- A Martínez-Berriotxoa
- Service of Internal Medicine, Hospital de Cruces Universidad del Pais Vasco/Euskal Herriko Unibertsitatea, Bizkaia, The Basque Country, Spain
| | | | | | | | | |
Collapse
|
16
|
Soares M, Reis L, Papi JAS, Cardoso CRL. Rate, pattern and factors related to damage in Brazilian systemic lupus erythematosus patients. Lupus 2016; 12:788-94. [PMID: 14596430 DOI: 10.1191/0961203303lu447xx] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Systemic Lupus InternationalCollaborating Clinics/American College of Rheumatology (ACR) Damage Index (SDI) is an accepted instrument to ascertain damage. It has been shown to vary among differentSLE populations.The aim of this study was to assess SDI score, pattern and factors related to damage in Brazilian SLE outpatients. The SDI was obtained in 105 patients with a median age of 41 (5-95%, 19-61.7) years and a median SLE duration of 127 (17.6-345.9) months. Patients had a median SDI of 2 (0-8) and 81.9% had some damage (SDI > 0). Damage was associatedwith a higher number of ACR criteria for SLE in multivariate analysis (OR 2.32, 95%CI 1.23-4.37, P 0.009). Antiphospholipid syndrome (APS) (OR 9.82, 95%CI 2.74-35.23, P < 0.001), methylprednisolone pulses (OR 3.91, 95%CI 1.19-12.81, P 0.024), age (OR 1.70, 95%CI 1.02-1.13, P 0.011) and prednisone use duration (OR 1.01, 95%CI 1.002-1.02, P 0.020) were related to severe damage (SDI ≥4). Hypertensionwas associated with renal, cardiac and atherosclerotic damage, as cyclophosphamide pulses were with premature menopause. In conclusion, damage was very frequent in Brazilian SLE patients, mainly due to skin involvement, compared to other SLE populations. The presence of APS was the major independent contributor to the development of severe damage. Arterial hypertension was identified as a common risk factor for renal, cardiac and atherosclerotic damage.
Collapse
Affiliation(s)
- Márcio Soares
- Internal Medicine Department, University Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.
| | | | | | | |
Collapse
|
17
|
Abstract
Systemic lupus erythematosus (SLE) is a complex autoimmune disease with variable clinical manifestations. While the clearest guidelines for the treatment of SLE exist in the context of lupus nephritis, patients with other lupus manifestations such as neuropsychiatric, hematologic, musculoskeletal, and severe cutaneous lupus frequently require immunosuppression and/or biologic therapy. Conventional immunosuppressive agents such as mycophenolate mofetil, azathioprine, and cyclophosphamide are widely used in the management of SLE with current more rationalized treatment regimens optimizing the use of these agents while minimizing potential toxicity. The advent of biologic therapies has advanced the treatment of SLE particularly in patients with refractory disease. The CD20 monoclonal antibody rituximab and the anti-BLyS agent belimumab are now widely in use in clinical practice. Several other biologic agents are in ongoing clinical trials. While immunosuppressive and biologic agents are the foundation of inflammatory disease control in SLE, the importance of managing comorbidities such as cardiovascular risk factors, bone health, and minimizing susceptibility to infection should not be neglected.
Collapse
Affiliation(s)
- Natasha Jordan
- Department of Rheumatology, Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - David D'Cruz
- Louise Coote Lupus Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| |
Collapse
|
18
|
Bundhun PK, Boodhoo KD, Long MY, Chen MH. Impact of Antiphospholipid Syndrome and/or Systemic Lupus Erythematosus on the Long-term Adverse Cardiovascular Outcomes in Patients After Percutaneous Coronary Intervention: A Systematic Review and Meta-analysis. Medicine (Baltimore) 2016; 95:e3200. [PMID: 27015221 PMCID: PMC4998416 DOI: 10.1097/md.0000000000003200] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Antiphospholipid syndrome (APS) and systemic lupus erythematosus (SLE) are 2 rare autoimmune disorders which commonly affect women. Several previous studies showed APS to have been evolved from SLE. Secondary APS often coexists with SLE. One common feature relating these 2 diseases are the antiphospholipid antibodies, which are found in most of the patients with APS and in approximately 30% to 40% of patients with SLE, among which, about 10% develop APS. The leading cause of death in these patients is from cardiovascular disease due to accelerated atherosclerosis, which often progresses more rapidly, compared with the general population. However, the impact of APS and/or SLE on the cardiovascular outcomes in patients undergoing percutaneous coronary intervention (PCI) is controversial. Therefore, to solve this issue, we aim to compare the long-term (≥1 year) adverse cardiovascular outcomes after PCI, in patients with APS and/or SLE, and those without these disorders.Medline and EMBASE databases were searched for studies comparing the long-term adverse cardiovascular outcomes between SLE and non-SLE, APS and non-APS, or SLE + APS and non-SLE + non-APS after PCI. We calculated odd ratios (OR) and 95% confidence intervals (CIs) for these categorical variables, and the pooled analyses were performed with RevMan 5.3.Seven studies consisting of a total of 253,436 patients (568 patients in the experimental group and 252,868 patients in the control group) were included in this meta-analysis. During a follow-up period of ≥1 year, mortality and myocardial Infarction (MI) were significantly higher in the experimental group (OR 2.02, 95% CI 1.63-2.49, P < 0.00001 and OR 1.59, 95% CI 1.23-2.05, P = 0.0004, respectively). Major adverse cardiac events and repeated revascularization were also significantly higher in the SLE/APS group (OR 2.40, 95% CI 1.42-4.03, P = 0.001 and OR 2.59, 95% CI 1.26-5.31, P = 0.01, respectively).Antiphospholipid syndrome and SLE are associated with significantly higher long-term (≥1 year) adverse cardiovascular outcomes after PCI. However, because of the limited number of patients and researches done, and due to a larger percentage of heterogeneity observed among several subgroups, this analysis may not generate a powerful result.
Collapse
Affiliation(s)
- Pravesh Kumar Bundhun
- From the Institute of Cardiovascular Diseases (PKB, M-YL, M-HC), the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi; and Department of Rheumatology (KDB), Xiangya Hospital, Central South University, Changsha, Hunan, China
| | | | | | | |
Collapse
|
19
|
Yuan J, Li LI, Wang Z, Song W, Zhang Z. Dyslipidemia in patients with systemic lupus erythematosus: Association with disease activity and B-type natriuretic peptide levels. Biomed Rep 2015; 4:68-72. [PMID: 26870337 DOI: 10.3892/br.2015.544] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 05/21/2015] [Indexed: 12/29/2022] Open
Abstract
The aim of the present study was to evaluate the association between the levels of lipids and B-type natriuretic peptide (BNP) in systemic lupus erythematosus (SLE) patients with heart failure (HF). A total of 46 patients with active SLE and 40 healthy, age-matched control subjects were studied. BNP was measured by an immunofluorescence assay in fresh plasma. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, apolipoprotein (Apo) B, ApoA-I and lipoprotein(a) were assessed. Compared with the control subjects, HDL-C and ApoA-I levels were considerably decreased and TG level increased markedly from SLE patients. The average concentration of HDL-C and ApoA-I in the SLE group with HF was significantly reduced compared to those patients without HF. The results showed that the levels of HDL-C and ApoA-I in SLE patients were negatively correlated with BNP. Disease activity was associated with the TC and TG levels. The present data indicated the presence of a cardiovascular (CV) risk in active SLE with high disease activity, which was demonstrated by the high frequency of dyslipidemia and higher BNP concentrations. Therefore, dyslipoproteinemia may underlie some of the increased risk for CV disease and HF in patients with SLE.
Collapse
Affiliation(s)
- Jiangshui Yuan
- Clinical Laboratory, Qingdao Municipal Hospital, Qingdao, Shandong 266011, P.R. China
| | - L I Li
- Clinical Laboratory, Qingdao Municipal Hospital, Qingdao, Shandong 266011, P.R. China
| | - Zhaoyan Wang
- Clinical Laboratory, Qingdao Municipal Hospital, Qingdao, Shandong 266011, P.R. China
| | - Weiqing Song
- Clinical Laboratory, Qingdao Municipal Hospital, Qingdao, Shandong 266011, P.R. China
| | - Zongliang Zhang
- Department of Urology, Qingdao Municipal Hospital, Qingdao, Shandong 266011, P.R. China
| |
Collapse
|
20
|
Muniz LF, Pereira RMR, Silva TF, Bonfá E, Borba EF. Impact of Therapy on Metabolic Syndrome in Young Adult Premenopausal Female Lupus Patients: Beneficial Effect of Antimalarials. Arthritis Care Res (Hoboken) 2015; 67:1255-1262. [DOI: 10.1002/acr.22593] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 02/18/2015] [Accepted: 03/24/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Luciana F. Muniz
- Faculdade de Medicina da Universidade de Sao PauloSao Paulo Brazil
| | | | - Thiago F. Silva
- Faculdade de Medicina da Universidade de Sao PauloSao Paulo Brazil
| | - Eloisa Bonfá
- Faculdade de Medicina da Universidade de Sao PauloSao Paulo Brazil
| | - Eduardo F. Borba
- Faculdade de Medicina da Universidade de Sao PauloSao Paulo Brazil
| |
Collapse
|
21
|
Arnaud L, Mathian A, Adoue D, Bader-Meunier B, Baudouin V, Belizna C, Bonnotte B, Boumedine F, Chaib A, Chauchard M, Chiche L, Daugas E, Ghali A, Gobert P, Gondran G, Guettrot-Imbert G, Hachulla E, Hamidou M, Haroche J, Hervier B, Hummel A, Jourde-Chiche N, Korganow AS, Kwon T, Le Guern V, Le Quellec A, Limal N, Magy-Bertrand N, Marianetti-Guingel P, Martin T, Martin Silva N, Meyer O, Miyara M, Morell-Dubois S, Ninet J, Papo T, Pennaforte JL, Polomat K, Pourrat J, Queyrel V, Raymond I, Remy P, Sacre K, Schmidt J, Sibilia J, Viallard JF, Viau Brabant A, Wahl D, Bruckert E, Amoura Z. [Screening and management of cardiovascular risk factors in systemic lupus erythematosus: Recommendations for clinical practice based on the literature and expert opinion]. Rev Med Interne 2014; 36:372-80. [PMID: 25455954 DOI: 10.1016/j.revmed.2014.10.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 04/17/2014] [Accepted: 10/13/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To develop French recommendations about screening and management of cardiovascular risk factors in systemic lupus erythematosus (SLE). METHODS Thirty-nine experts qualified in internal medicine, rheumatology and nephrology have selected recommendations from a list developed based on evidence from the literature. For each recommendation, the level of evidence and the level of agreement among the experts were specified. RESULTS Experts recommended an annual screening of cardiovascular risk factors in SLE. Statins should be prescribed for primary prevention in SLE patients based on the level of LDL-cholesterol and the number of cardiovascular risk factors, considering SLE as an additional risk factor. For secondary prevention, experts have agreed on an LDL-cholesterol target of <0.7 g/L. Hypertension should be managed according to the 2013 European guidelines, using renin-angiotensin system blockers as first line agents in case of renal involvement. Aspirin can be prescribed in patients with high cardiovascular risk or with antiphospholipid antibodies. CONCLUSION These recommendations about the screening and management of cardiovascular risk factors in SLE can be expected to improve clinical practice uniformity and, in the longer term, to optimize the management of SLE patients.
Collapse
Affiliation(s)
- L Arnaud
- Service de médecine interne 2, Centre national de référence du lupus systémique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne universités, UPMC université Paris 06, 75013 Paris, France.
| | - A Mathian
- Service de médecine interne 2, Centre national de référence du lupus systémique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne universités, UPMC université Paris 06, 75013 Paris, France
| | - D Adoue
- Service de médecine interne et immunopathologie clinique, hôpital Purpan, Toulouse, France
| | - B Bader-Meunier
- Service d'immunologie et rhumatologie pédiatrique, centre de référence des maladies rares rhumatologiques et inflammatoires pédiatriques (CERHUMIP), hôpital Necker, Paris, France
| | - V Baudouin
- Service de néphrologie pédiatrique, hôpital Robert-Debré, Paris, France
| | - C Belizna
- Service de médecine interne, CHU d'Angers, Angers, France
| | - B Bonnotte
- Service de médecine interne et immunologie clinique, CHU Bocage, Dijon, France
| | - F Boumedine
- Service de médecine interne 2, Centre national de référence du lupus systémique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Chaib
- Service de médecine interne 2, Centre national de référence du lupus systémique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - M Chauchard
- Service de médecine interne, hôpital Bichat, Claude-Bernard, Paris, France
| | - L Chiche
- Service de médecine interne, hôpital de la Conception, Marseille, France
| | - E Daugas
- Service de néphrologie, hôpital Bichat, Paris, France
| | - A Ghali
- Service de médecine interne, CHU d'Angers, Angers, France
| | - P Gobert
- Service de médecine interne et néphrologie, centre hospitalier d'Avignon, Avignon, France
| | - G Gondran
- Service de médecine interne A, hôpital Dupuytren, CHU de Limoges, Limoges, France
| | - G Guettrot-Imbert
- Service de médecine interne, hôpital Gabriel-Montpied, CHU, Clermont-Ferrand, France
| | - E Hachulla
- Service de médecine interne, hôpital Claude-Huriez, CHRU de Lille, Lille, France
| | - M Hamidou
- Service de médecine interne, Nantes, France
| | - J Haroche
- Service de médecine interne 2, Centre national de référence du lupus systémique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne universités, UPMC université Paris 06, 75013 Paris, France
| | - B Hervier
- Service de médecine interne 2, Centre national de référence du lupus systémique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - A Hummel
- Service de néphrologie adulte, hôpital Necker, Paris, France
| | - N Jourde-Chiche
- Service de néphrologie, hôpital de la Conception, Marseille, France
| | - A-S Korganow
- Service d'immunologie clinique, hôpital civil, CHU de Strasbourg, Strasbourg, France
| | - T Kwon
- Service de néphrologie pédiatrique, hôpital Robert-Debré, Paris, France
| | - V Le Guern
- Service de médecine interne, centre de référence maladies systémiques et auto-immunes rares, sclérodermies, vascularites, groupe hospitalier Cochin, Paris, France
| | - A Le Quellec
- Service de médecine interne A, hôpital Saint-Éloi, Montpellier, France
| | - N Limal
- Service de médecine interne, CHU Henri-Mondor, Créteil, France
| | - N Magy-Bertrand
- Service de médecine interne, CHU Jean-Minjoz, Besançon, France
| | | | - T Martin
- Service d'immunologie clinique, hôpital civil, CHU de Strasbourg, Strasbourg, France
| | | | - O Meyer
- Service de rhumatologie, hôpital Bichat-Claude-Bernard, Paris, France
| | - M Miyara
- Service de médecine interne 2, Centre national de référence du lupus systémique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France
| | - S Morell-Dubois
- Service de médecine interne, hôpital Claude-Huriez, CHRU de Lille, Lille, France
| | - J Ninet
- Service de médecine interne, hôpital Édouard-Herriot, CHRU de Lyon, Lyon, France
| | - T Papo
- Service de médecine interne, hôpital Bichat, Claude-Bernard, Paris, France
| | - J-L Pennaforte
- Service de médecine interne, CHU de Reims, Reims, France
| | - K Polomat
- Service de médecine interne 5D, CHU de Martinique, Fort-de-France, Martinique
| | - J Pourrat
- Service de néphrologie, hôpital Rangueil, CHU, Toulouse, France
| | - V Queyrel
- Service de médecine interne, hôpital de l'Archet, Nice, France
| | - I Raymond
- Service de médecine interne et maladies infectieuses, hôpital Haut-Lévêque, centre François-Magendie, Pessac, France
| | - P Remy
- Service de néphrologie, groupe hospitalier Henri-Mondor, Créteil, France
| | - K Sacre
- Service de médecine interne, hôpital Bichat, Claude-Bernard, Paris, France
| | - J Schmidt
- Service de médecine interne, CHU Nord, Amiens, France
| | - J Sibilia
- Service de rhumatologie, CHU Hautepierre, Strasbourg, France
| | - J-F Viallard
- Service de médecine interne et maladies infectieuses, hôpital Haut-Lévêque, centre François-Magendie, Pessac, France
| | - A Viau Brabant
- Service de médecine interne, CHU de Reims, Reims, France
| | - D Wahl
- Inserm U 1116, service de médecine vasculaire, département de médecine interne, institut lorrain du cœur et des vaisseaux Louis-Mathieu, centre de compétence régional des maladies systémiques et auto-immunes rares, CHU de Nancy, université de Lorraine, Vandœuvre-lès-Nancy, France
| | - E Bruckert
- Service d'endocrinologie, métabolisme et prévention cardiovasculaire, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - Z Amoura
- Service de médecine interne 2, Centre national de référence du lupus systémique, groupe hospitalier Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75013 Paris, France; Sorbonne universités, UPMC université Paris 06, 75013 Paris, France
| | | |
Collapse
|
22
|
Arnaud L, Mathian A, Bruckert E, Amoura Z. Le risque cardiovasculaire au cours du lupus systémique. Rev Med Interne 2014; 35:723-9. [DOI: 10.1016/j.revmed.2014.07.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 03/02/2014] [Accepted: 07/28/2014] [Indexed: 11/28/2022]
|
23
|
Smrzova A, Horak P, Skacelova M, Hermanova Z, Langova K, Zadrazil J, Novotny D. Intima media thickness measurement as a marker of subclinical atherosclerosis in SLE patient. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2014; 158:404-11. [DOI: 10.5507/bp.2013.054] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 07/08/2013] [Indexed: 11/23/2022] Open
|
24
|
Lertratanakul A, Wu P, Dyer A, Urowitz M, Gladman D, Fortin P, Bae SC, Gordon C, Clarke A, Bernatsky S, Hanly JG, Isenberg D, Rahman A, Merrill J, Wallace DJ, Ginzler E, Khamashta M, Bruce I, Nived O, Sturfelt G, Steinsson K, Manzi S, Dooley MA, Kalunian K, Petri M, Aranow C, Font J, van Vollenhoven R, Stoll T, Ramsey-Goldman R. 25-hydroxyvitamin D and cardiovascular disease in patients with systemic lupus erythematosus: data from a large international inception cohort. Arthritis Care Res (Hoboken) 2014; 66:1167-76. [PMID: 24470118 PMCID: PMC4844829 DOI: 10.1002/acr.22291] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 01/21/2014] [Indexed: 11/07/2022]
Abstract
OBJECTIVE An association between 25-hydroxyvitamin D (25[OH]D; vitamin D) deficiency and increased cardiovascular (CV) risk factors and CV disease (CVD) has been shown in general population studies. Vitamin D deficiency has been noted in systemic lupus erythematosus (SLE), and CVD is a major cause of morbidity and mortality in SLE. The objectives of this study were to estimate the associations of 25(OH)D levels with CV risk factors and to determine whether low baseline 25(OH)D levels predict future CV events in patients participating in an international inception cohort. METHODS Data were collected on 890 participants, including demographics, SLE activity and damage assessments, CV risk factors and events, medications, laboratory assessments of 25(OH)D levels, and inflammatory markers. Multiple logistic and Cox regressions were used to estimate the associations of baseline 25(OH)D levels with baseline CV risk factors and CVD events. The models were adjusted for age, sex, race, season, and country, with and without body mass index. RESULTS Patients in the higher quartiles of 25(OH)D were less likely to have hypertension and hyperlipidemia and were more likely to have lower C-reactive protein levels and lower Systemic Lupus Erythematosus Disease Activity Index 2000 scores at baseline when compared with the first quartile. Vitamin D levels were not independently associated with CVD event incidence; however, hazard ratios for CVD event incidence decreased with successively higher quartiles. CONCLUSION Lower baseline 25(OH)D levels are associated with higher risk for CV risk factors and more active SLE at baseline. There may be a trend toward a lower likelihood of CVD events in those with higher baseline 25(OH)D levels.
Collapse
|
25
|
Deák M, Bocskai M, Burcsár S, Dányi O, Fekete Z, Kovács L. Non-thromboembolic risk in systemic lupus erythematosus associated with antiphospholipid syndrome. Lupus 2014; 23:913-8. [DOI: 10.1177/0961203314531839] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 03/25/2014] [Indexed: 02/04/2023]
Abstract
Objectives We investigated the impact of secondary antiphospholipid syndrome (APS) and antiphospholipid antibody (aPL) positivity on the non-thromboembolic clinical manifestations of systemic lupus erythematosus (SLE). Methods In total, 224 patients with SLE were studied, of whom 105 were aPL-positive; 52 fulfilled the criteria for APS. SLE- and APS-related clinical and laboratory features were assesed: SLE patients with aPL or APS were compared with those without these features. Results Not only thromboembolic events, but also Coombs-positive haemolytic anaemia, thrombocytopenia and endocarditis occurred significantly more frequently in the aPL-positive than in the aPL-negative patients. In the APS + SLE subgroup, several non-thromboembolic symptoms occurred more often than in the absence of APS: pleuritis, interstitial lung disease, myocarditis, nephritis and organic brain syndrome. The mean number of major organ manifestations (1.2 vs. 0.5) and the overall number of organ manifestations (8.1 vs. 6.9) were higher in the APS + SLE patients than in those without APS ( p < 0.05). The APS + SLE subgroup more frequently required intensive immunosuppressive treatment than did the APS-negative patients ( p < 0.05). Conclusions SLE patients with aPL positivity or secondary APS also have a higher risk to develop non-thromboembolic disease manifestations in addition to the aPL-related symptoms, and are predisposed to more severe SLE manifestations.
Collapse
Affiliation(s)
- M Deák
- Department of Rheumatology, University of Szeged, Faculty of Medicine, Albert Szent-Györgyi Health Centre, Szeged, Hungary
| | - M Bocskai
- Department of Rheumatology, University of Szeged, Faculty of Medicine, Albert Szent-Györgyi Health Centre, Szeged, Hungary
| | - S Burcsár
- Department of Rheumatology, University of Szeged, Faculty of Medicine, Albert Szent-Györgyi Health Centre, Szeged, Hungary
| | - O Dányi
- Department of Rheumatology, University of Szeged, Faculty of Medicine, Albert Szent-Györgyi Health Centre, Szeged, Hungary
| | - Z Fekete
- Department of Rheumatology, University of Szeged, Faculty of Medicine, Albert Szent-Györgyi Health Centre, Szeged, Hungary
| | - L Kovács
- Department of Rheumatology, University of Szeged, Faculty of Medicine, Albert Szent-Györgyi Health Centre, Szeged, Hungary
| |
Collapse
|
26
|
Carotid intima media thickness as a marker of atherosclerosis in ankylosing spondylitis. Int J Rheumatol 2014; 2014:839135. [PMID: 24803936 PMCID: PMC3997910 DOI: 10.1155/2014/839135] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 03/13/2014] [Accepted: 03/13/2014] [Indexed: 11/17/2022] Open
Abstract
Aim. Increased cardiovascular morbidity and mortality have been observed in ankylosing spondylitis because of accelerated atherosclerosis. We measured carotid intima media thickness (CIMT) as a surrogate marker of atherosclerosis in this study. Methods. In this study 37 cases of AS and the same number of matched individuals were recruited. CIMT measurements were done using B-mode ultrasound. Disease activity was assessed using Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), and Bath ankylosing spondylitis metrological index (BASMI) scores and C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) levels. Results. Mean age of the study groups was 29.43 ± 9.00 years. Average disease duration was 65.62 ± 54.92 months. Twenty-eight (75.68%) of cases were HLA B-27 positive. A significantly increased CIMT was observed in cases as compared to control group (0.62 ± 0.12 versus 0.54 ± 0.04; P < 0.001). CIMT in the cases group positively correlated with age (r = 0.357; P < 0.05), duration of disease (r = 0.549; P < 0.01), and BASMI (r = 0.337; P < 0.05) and negatively correlated with ESR (r = -0.295; P < 0.05). Conclusions. Patients of AS had a higher CIMT than those of the control group. CIMT correlated with disease chronicity.
Collapse
|
27
|
Abstract
Rheumatic diseases are associated with an increased risk of cardiovascular (CV) mortality attributed to a higher incidence of heart failure (HF) and ischemic heart disease. Although traditional CV risk factors contribute to the increased incidence seen in this population, by themselves they do not account for the increased risk; in fact, obesity and hyperlipidemia may play a paradoxic role. Immune-mediated mechanisms and chronic inflammation likely play a role in the pathogenesis of CV disease in patients with rheumatic diseases. The usual clinical features of ischemic heart disease and HF are less likely to be seen in this patient population.
Collapse
Affiliation(s)
- Kerry Wright
- Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Cynthia S Crowson
- Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| | - Sherine E Gabriel
- Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| |
Collapse
|
28
|
|
29
|
Park YJ, Shin YJ, Kim WU, Cho CS. Prediction of subclinical atherosclerosis by serum osteoprotegerin in premenopausal women with systemic lupus erythematous: correlation of osteoprotegerin with monocyte chemotactic protein-1. Lupus 2014; 23:236-44. [DOI: 10.1177/0961203313517151] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objective Patients with systemic lupus erythematosus (SLE) have increased risk for cardiovascular disease. Previous studies disclosed the association of serum osteoprotegerin (OPG) with the presence of symptomatic atherosclerosis in the general population and several disease conditions. We thus investigated the association between serum OPG levels and subclinical atherosclerosis in premenopausal SLE patients. Methods Serum OPG levels and carotid artery intima-media thickness (IMT) were measured in 181 premenopausal SLE patients and age-matched 85 control subjects. Traditional cardiovascular risk factors and SLE-related factors were analyzed. Results Patients with SLE had significantly increased serum OPG levels (1086 versus 517 pg/ml, p < 0.001) and carotid IMT (0.63 versus 0.45 mm, p < 0.001) compared with control subjects. Carotid IMT significantly increased across the quartiles of OPG. Logistic regression analysis revealed that compared to the lowest OPG quartile, the odds ratio (OR, 95% confidence interval) for increased carotid IMT in quartile 2, 3, and 4 was 1.126 (1.013–1.801), 1.562 (1.268–2.799), and 4.460 (1.126–7.128), respectively, after multiple adjustments ( p for trend across quartiles < 0.001). These associations remained significant after further adjustment for inflammatory parameters. Interestingly, serum monocyte chemotactic protein-1 (MCP-1) levels were positively correlated with serum OPG levels (γ = 0.332, p < 0.001). Parallel analysis showed that serum MCP-1 was also an independent predictor of carotid IMT incrassation, but this association was lost when serum OPG was included in the model. Conclusion Serum OPG levels were increased and correlated with serum MCP-1 levels in premenopausal SLE patients. Increased serum OPG was independently associated with subclinical atherosclerosis in these patients.
Collapse
Affiliation(s)
- Y-J Park
- Division of Rheumatology, Department of Internal Medicine, St. Vincent Hospital, The Catholic University of Korea, Suwon, Korea
| | - Y-J Shin
- Division of Rheumatology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - W-U Kim
- Division of Rheumatology, Department of Internal Medicine, St. Vincent Hospital, The Catholic University of Korea, Suwon, Korea
| | - C-S Cho
- Division of Rheumatology, Department of Internal Medicine, Yeouido St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| |
Collapse
|
30
|
Mak A. Orthopedic surgery and its complication in systemic lupus erythematosus. World J Orthop 2014; 5:38-44. [PMID: 24653977 PMCID: PMC3955778 DOI: 10.5312/wjo.v5.i1.38] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 09/28/2013] [Accepted: 10/18/2013] [Indexed: 02/06/2023] Open
Abstract
Systemic lupus erythematosus (SLE) is a multi-systemic immune-complex mediated autoimmune condition which chiefly affects women during their prime year. While the management of the condition falls into the specialty of internal medicine, patients with SLE often present with signs and symptoms pertaining to the territory of orthopedic surgery such as tendon rupture, carpal tunnel syndrome, osteonecrosis, osteoporotic fracture and infection including septic arthritis, osteomyelitis and spondylodiscitis. While these orthopedic-related conditions are often debilitating in patients with SLE which necessitate management by orthopedic specialists, a high index of suspicion is necessary in diagnosing these conditions early because lupus patients with potentially severe orthopedic conditions such as osteomyelitis frequently present with mild symptoms and subtle signs such as low grade fever, mild hip pain and back tenderness. Additionally, even if these orthopedic conditions can be recognized, complications as a result of surgical procedures are indeed not uncommon. SLE per se and its various associated pharmacological treatments may pose lupus patients to certain surgical risks if they are not properly attended to and managed prior to, during and after surgery. Concerted effort of management and effective communication among orthopedic specialists and rheumatologists play an integral part in enhancing favorable outcome and reduction in postoperative complications for patients with SLE through thorough pre-operative evaluation, careful peri-operative monitoring and treatment, as well as judicious postoperative care.
Collapse
|
31
|
Kim JY, Park YJ, Kim KJ, Choi JJ, Kim WU, Cho CS. Osteoprotegerin causes apoptosis of endothelial progenitor cells by induction of oxidative stress. ACTA ACUST UNITED AC 2013; 65:2172-82. [PMID: 23666878 DOI: 10.1002/art.37997] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 04/24/2013] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Elevated serum osteoprotegerin (OPG) levels represent an independent risk factor for atherosclerotic disease, although the underlying mechanism is not clear. The aim of this study was to investigate the association of serum OPG levels and circulating endothelial progenitor cell (EPC) numbers, and to explore the effect of OPG on EPC apoptosis and its underlying mechanisms. METHODS Flow cytometry was used to enumerate EPCs in the peripheral blood of 91 patients with systemic lupus erythematosus (SLE). Cultured EPCs, isolated from peripheral blood, were challenged with OPG, and apoptosis was evaluated by TUNEL staining. Expression of apoptosis-related proteins was measured by real-time quantitative polymerase chain reaction (qPCR) and Western blotting. Reactive oxygen species (ROS) were detected by flow cytometry, and the expression of NADPH oxidase (NOX) and MAP kinases (MAPK) was measured by qPCR and Western blotting. RESULTS The serum OPG level was independently associated with reduced numbers of EPCs in patients with SLE. In vitro treatment with OPG significantly induced apoptosis of EPCs; this effect was mediated by syndecan 4. OPG-induced apoptosis was abolished by the ROS scavenger N-acetylcysteine and the NOX inhibitor diphenyleniodonium. OPG increased ROS production through activation of NOX-2 and NOX-4 and triggered phosphorylation of ERK-1/2 and p38 MAPK. Quenching of ROS by knockdown of NOX-2 or NOX-4 transcripts inhibited phosphorylation of ERK-1/2 and p38 MAPK. Moreover, inhibitors of ERK-1/2 and p38 MAPK decreased ROS production and subsequent EPC apoptosis, indicating a feed-forward loop between NOX and MAPK to amplify ROS production related to apoptosis. CONCLUSION Elevated OPG levels increase apoptosis of EPCs by induction of oxidative stress.
Collapse
Affiliation(s)
- Ji-Young Kim
- Catholic Research Institutes of Medical Sciences, Seoul, Republic of Korea
| | | | | | | | | | | |
Collapse
|
32
|
Management of women with systemic lupus erythematosus. Maturitas 2013; 75:207-14. [DOI: 10.1016/j.maturitas.2013.03.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 03/10/2013] [Indexed: 01/30/2023]
|
33
|
Complement system and small HDL particles are associated with subclinical atherosclerosis in SLE patients. Atherosclerosis 2012; 225:224-30. [DOI: 10.1016/j.atherosclerosis.2012.08.029] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 08/09/2012] [Accepted: 08/23/2012] [Indexed: 01/11/2023]
|
34
|
Causes and predictors of mortality in hospitalized lupus patient in Sarawak General Hospital, Malaysia. Lupus 2012; 22:106-11. [DOI: 10.1177/0961203312465780] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Systemic lupus erythematosus (SLE) is a serious autoimmune disease that can be life threatening and fatal if left untreated. Causes and prognostic indicators of death in SLE have been well studied in developed countries but lacking in developing countries. We aimed to investigate the causes of mortality in hospitalized patients with SLE and determine the prognostic indicators of mortality during hospitalization in our center. All SLE patients who were admitted to Sarawak General Hospital from January 1, 2006 to December 31, 2010, were followed up in a prospective study using a standard protocol. Demographic data, clinical features, disease activities and damage indices were collected. Logistic regression and Cox regression analysis were used to determine the prognostic indicators of mortality in our patients. There were a total of 251 patients in our study, with the female to male ratio 10 to 1. Our study patients were of multiethnic origins. They had a mean age of 30.5 ± 12.2 years and a mean duration of illness of 36.5 ± 51.6 months. The main involvements were hematologic (73.3%), renal (70.9%) and mucocutaneous (67.3%). There were 26 deaths (10.4%), with the main causes being: infection and flare (50%), infection alone (19%), flare alone (19%) and others (12%). Independent predictors of mortality in our cohort of SLE patients were the presence of both infection and flare of disease (hazard ratio (HR) 5.56) and high damage indices at the time of admission (HR 1.91). Infection and flare were the main causes of death in hospitalized Asian patients with SLE. The presence of infection with flare and high damage indices at the time of admission were independent prognostic indicators of mortality.
Collapse
|
35
|
Pramanik AB, Bhattacharyya K, Sinha PK, Sarkar RN, Paul R, Das R, Mani S, Bhattacharya R. Study of endothelial dysfunction and its correlation with disease activity in systemic lupus erythematosus patients without conventional cardiovascular risk factors. INDIAN JOURNAL OF RHEUMATOLOGY 2011. [DOI: 10.1016/s0973-3698(11)60204-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
|
36
|
Touma Z, Gladman DD, Ibanez D, Urowitz MB. Ability of non-fasting and fasting triglycerides to predict coronary artery disease in lupus patients. Rheumatology (Oxford) 2011; 51:528-34. [DOI: 10.1093/rheumatology/ker339] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
37
|
Aghdassi E, Ma DWL, Morrison S, Hillyer LM, Clarke S, Gladman DD, Urowitz MB, Fortin PR. Alterations in circulating fatty acid composition in patients with systemic lupus erythematosus: a pilot study. JPEN J Parenter Enteral Nutr 2011; 35:198-208. [PMID: 21378249 DOI: 10.1177/0148607110386378] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Circulating fatty acids (FAs) may play a role in the disease pathogenesis of patients with systemic lupus erythematosus (SLE). OBJECTIVES To compare red blood cell (RBC) and plasma FA composition: (1) between female SLE patients and age-matched healthy female (HF) controls and in SLE with history of cardiovascular disease (CVD) and those with no history (SLE+CVD vs SLE-CVD); and (2) between SLE patients who were or were not receiving prednisone treatment at the time of blood sampling. METHODS This cross-sectional study consisted of 33 female patients with SLE (11 SLE+CVD, 22 SLE-CVD) and 20 HF controls. Demographics, CVD risk, medication profile, blood biochemistry, and FA composition of RBC and plasma total lipids were determined. RESULTS Waist circumference and body mass index were higher in SLE patients than in HF controls. These variables along with serum triglycerides, blood glucose, and systolic blood pressure were higher in SLE+CVD than SLE-CVD patients. RBC FA composition showed lower eicosapentaenoic acid (EPA, ω-3 active metabolite) and ω-3 index (EPA+ docosahexaenoic acid) in SLE patients compared with HF controls. The ratio of the RBC inflammatory metabolite, arachidonic acid, to the anti-inflammatory metabolite EPA was also significantly higher in SLE patients than in HF controls. No differences were seen in plasma FA between SLE and HF groups. However, SLE-CVD patients had a more favorable lipid profile than SLE+CVD patients. In SLE patients, the use of prednisone resulted in alteration of both RBC and plasma FA composition. CONCLUSION SLE patients, regardless of their history of CVD, have altered plasma and RBC FA composition favoring inflammation. The use of prednisone was associated with differences in FA profile.
Collapse
Affiliation(s)
- Elaheh Aghdassi
- Division of Health Care and Outcome Research, Toronto Western Research Institute, Ontario, Canada
| | | | | | | | | | | | | | | |
Collapse
|
38
|
Kang KY, Kwok SK, Ju JH, Park KS, Cho CS, Kim HY, Park SH. The causes of death in Korean patients with systemic lupus erythematosus over 11 years. Lupus 2011; 20:989-97. [PMID: 21700655 DOI: 10.1177/0961203311402245] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We investigated the causes of death and analyzed the prognostic factors in Korean systemic lupus erythematosus (SLE) patients. We evaluated 1010 patients with SLE who visited Seoul Saint Mary's Hospital from 1997-2007. Changing patterns in the causes of death were analyzed. Survival rate was calculated by the Kaplan-Meier method and the log-rank test. The risk factors for death were analyzed by multivariate logistic regression analysis. The 5-year survival rate was 97.8%. Over the period of the study, 59 deaths were observed. Among 44 patients who died in our hospital, the most common cause of death was infection (37.3%), with SLE-related death as the next most frequent cause (22.0%). In comparison with earlier data, the proportion of SLE-related deaths has fallen and the proportion of infections has risen. SLE-related death was the most frequent cause of early death, while infection was the most common cause of death in the overall population. In univariate analysis, damage related to SLE, cumulative glucocorticoid dose, mean glucocorticoid dose for 1 month before death, intravenous methylprednisolone therapy and cyclophosphamide treatment were associated with death (p < 0.001 each). The late onset of SLE and renal involvement were predictive factors of poor outcome (p = 0.03 and p < 0.001). In multivariate analysis, the risk factors for death were irreversible damage related to SLE, cyclophosphamide therapy and mean glucocorticoid dose for 1 month before death. The most common cause of death in Korean SLE patients was infection. The judicious use of immunosuppressive agents may be important to decrease infection and to improve survival in SLE patients.
Collapse
Affiliation(s)
- K Y Kang
- Division of Rheumatology, Department of Internal Medicine, Medical College, Chungbuk National University, Cheongju, South Korea
| | | | | | | | | | | | | |
Collapse
|
39
|
Soltész P, Kerekes G, Dér H, Szücs G, Szántó S, Kiss E, Bodolay E, Zeher M, Timár O, Szodoray P, Szegedi G, Szekanecz Z. Comparative assessment of vascular function in autoimmune rheumatic diseases: considerations of prevention and treatment. Autoimmun Rev 2011; 10:416-25. [PMID: 21281743 DOI: 10.1016/j.autrev.2011.01.004] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2011] [Accepted: 01/08/2011] [Indexed: 12/31/2022]
Abstract
Numerous autoimmune-inflammatory rheumatic diseases have been associated with accelerated atherosclerosis or other types of vasculopathy leading to increased cardio- and cerebrovascular disease risk. Traditional risk factors, as well as the role of systemic inflammation including cytokines, chemokines, proteases, autoantibodies, adhesion receptors and others have been implicated in the development of these vascular pathologies. The characteristics of vasculopathies may significantly differ depending on the underlying disease. While classical accelerated atherosclerosis has been associated with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE) or spondyloarthropathies (SpA), obliterative vasculopathy may rather be characteristic for systemic sclerosis (SSc) or mixed connective tissue disease (MCTD). Antiphospholipid antibodies have been implicated in vasculopathies underlying SLE, antiphospholipid syndrome (APS), RA and MCTD. There is also heterogeneity with respect to inflammatory risk factors. Cytokines, such as tumor necrosis factor-α (TNF-α) or interleukin 6 (IL-6) and immune complexes are primarily involved in arthritides, such as RA, SpA, as well as in SLE. On the other hand, autoantibodies including anti-oxLDL anti-cardiolipin and anti-β2GPI are rather involved in SLE- and APS-associated vasculopathies. Regarding the non-invasive assessment of vascular function, endothelial dysfunction, overt atherosclerosis and vascular stiffness may be indicated by brachial artery flow-mediated vasodilation (FMD), common carotid intima-media thickness (ccIMT) and aortic pulse-wave velocity (PWV), respectively. These abnormalities have been described in most inflammatory rheumatic diseases. While ccIMT and stiffness are relatively stable, FMD may be influenced by many confounding factors. In addition to traditional vasculoprotection, immunosuppressive agents including corticosteroids, traditional and biologic DMARDs may have significant vascular and metabolic effects. The official EULAR recommendations on the assessment and management of cardiovascular disease in arthritides have just been published, and similar recommendations in connective tissue diseases are to be developed soon.
Collapse
Affiliation(s)
- Pál Soltész
- University of Debrecen Medical and Health Sciences Center, Institute of Medicine, Third Department of Medicine, Angiology and Intensive Care Unit, Debrecen, Hungary
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
The heart in rheumatic disease. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00034-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
41
|
Aghdassi E, Zhang W, St-Pierre Y, Clarke AE, Morrison S, Peeva V, Landolt-Marticorena C, Su J, Reich H, Scholey J, Herzenberg A, Pope JE, Peschken C, Wither JE, Fortin PR. Healthcare cost and loss of productivity in a Canadian population of patients with and without lupus nephritis. J Rheumatol 2010; 38:658-66. [PMID: 21159829 DOI: 10.3899/jrheum.100482] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the healthcare cost and loss of productivity in patients with systemic lupus erythematosus (SLE) with (LN) and without lupus nephritis (lupus nephritis-negative, LNN). METHOD Patients were classified into those with active (ALN and ALNN) and inactive disease (ILN and ILNN). Patients reported on visits to healthcare professionals and use of diagnostic tests, medications, assistive devices, alternative treatments, hospital emergency visits, surgical procedures, and hospitalizations as well as loss of productivity in the 4 weeks preceding enrollment. RESULTS Enrollment was 141 patients, 79 with LN and 62 LNN. Patients with LN were more likely to visit rheumatologists and nephrologists, undergo diagnostic tests, and had higher costs for medications than patients who were LNN. The annual healthcare cost averaged $CAN 12,597 ± 9946 for patients with LN and $10,585 ± 13,149 for patients who were LNN, a difference of $2012 (95% CI -$2075, $6100). Patients with ALN had more diagnostic tests and surgical procedures, contributing to a significantly higher annual direct cost ($14,224 ± 10,265) compared to patients with ILN ($9142 ± 8419) and a difference of $5082 (95% CI $591, $9573). The healthcare cost was not different between patients with ALNN and patients with ILNN. In patients with LN and patients who were LNN, < 50% were employed and on average missed 6.5-9 days of work per month. The loss of productivity was significantly higher for caregivers of patients with LN than caregivers of patients who were LNN. CONCLUSION Healthcare cost and loss of productivity were similar between patients with LN and patients who were LNN; the loss of productivity for caregivers is higher for patients with LN; and the healthcare cost is greater in ALN than in ILN.
Collapse
Affiliation(s)
- Elaheh Aghdassi
- Department of Medicine, Division of Rheumatology, University Health Network, University of Toronto, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Reiss AB, Anwar K, Merrill JT, Chan ESL, Awadallah NW, Cronstein BN, Michael Belmont H, Belilos E, Rosenblum G, Belostocki K, Bonetti L, Hasneen K, Carsons SE. Plasma from systemic lupus patients compromises cholesterol homeostasis: a potential mechanism linking autoimmunity to atherosclerotic cardiovascular disease. Rheumatol Int 2010; 30:591-8. [PMID: 19547978 PMCID: PMC3736583 DOI: 10.1007/s00296-009-1020-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2008] [Accepted: 06/05/2009] [Indexed: 01/06/2023]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) contributes to morbidity and mortality in systemic lupus erythematosus (SLE). Immunologic derangements may disrupt cholesterol balance in vessel wall monocytes/macrophages and endothelium. We determined whether lupus plasma impacts expression of cholesterol 27-hydroxylase, an anti-atherogenic cholesterol-degrading enzyme that promotes cellular cholesterol efflux, in THP-1 human monocytes and primary human aortic endothelial cells (HAEC). THP-1 monocytes and HAEC were incubated in medium containing SLE patient plasma or apparently healthy control human plasma (CHP). SLE plasma decreased 27-hydroxylase message in THP-1 monocytes by 47 +/- 8% (p < 0.008) and in HAEC by 51 +/- 5.5% (n = 5, p < 0.001). THP-1 macrophages were incubated in 25% lupus plasma or CHP and cholesterol-loaded (50 microg ml(-1) acetylated low density lipoprotein). Lupus plasma more than doubled macrophage foam cell transformation (74 +/- 3% vs. 35 +/- 3% for CHP, n = 3, p < 0.001). Impaired cholesterol homeostasis in SLE provides further evidence of immune involvement in atherogenesis. Strategies to inhibit or reverse arterial cholesterol accumulation may benefit SLE patients.
Collapse
Affiliation(s)
- Allison B Reiss
- Department of Medicine, Vascular Biology Institute, Division of Rheumatology, Allergy and Immunology, Winthrop-University Hospital, 222 Station Plaza, North, Suite 502, Mineola, NY 11501, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Elliott JR, Manzi S. Cardiovascular risk assessment and treatment in systemic lupus erythematosus. Best Pract Res Clin Rheumatol 2009; 23:481-94. [PMID: 19591779 DOI: 10.1016/j.berh.2009.03.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
With improved treatment modalities and survival rates, patients with systemic lupus erythematosus live longer and their co-morbidities have become more apparent. Of great concern is cardiovascular disease, which has become a leading cause of death. Lupus patients prematurely develop atherosclerosis, which likely arises from an interaction among traditional cardiovascular risk factors, factors specific to lupus itself and inflammatory mediators. Despite these findings, lupus patients are not always adequately evaluated for traditional risk factors, many of which are treatable and reversible. We propose that lupus patients be assessed and managed regarding cardiovascular risk factors in the same manner as patients with known cardiovascular disease. As a result, preventive cardiology should be considered an essential component of the care for patients with lupus.
Collapse
|
44
|
Wright SA, O’Prey FM, Hamilton PK, Lockhart CJ, McCann A, McHenry MT, McGivern RC, Plumb R, Finch MB, Bell AL, McVeigh GE. Colour Doppler ultrasound of the ocular circulation in patients with systemic lupus erythematosus identifies altered microcirculatory haemodynamics. Lupus 2009; 18:950-7. [DOI: 10.1177/0961203309104865] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We assessed whether quantitative analysis of Doppler flow velocity waveforms is able to identify subclinical microvascular abnormalities in SLE and whether eigenvector analysis can detect changes not detectable using the resistive index (RI). Fifty-four SLE patients with no conventional cardiovascular risk factors, major organ involvement or retinopathy were compared to 32 controls. Flow velocity waveforms were obtained from the ophthalmic artery (OA), central retinal artery (CRA) and common carotid artery (CA). The waveforms were analysed using eigenvector decomposition and compared between groups at each arterial site. The RI was also determined. The RI was comparable between groups. In the OA and CRA, there were significant differences in the lower frequency sinusoidal components ( P < 0.05 for each component). No differences were apparent in the CA between groups. Eigenvector analysis of Doppler flow waveforms, recorded in proximity of the terminal vascular bed, identified altered ocular microvascular haemodynamics in SLE. Altered waveform structure could not be identified by changes in RI, the traditional measure of downstream vascular resistance. This analytical approach to waveform analysis is more sensitive in detecting preclinical microvascular abnormalities in SLE. It may hold potential as a useful tool for assessing disease activity, response to treatment, and predicting future vascular complications.
Collapse
Affiliation(s)
- SA Wright
- Department of Therapeutics and Pharmacology, Queen’s University Belfast, Northern Ireland; Lupus Research Group, Queen’s University Belfast, Northern Ireland
| | - FM O’Prey
- Department of Therapeutics and Pharmacology, Queen’s University Belfast, Northern Ireland
| | - PK Hamilton
- Department of Therapeutics and Pharmacology, Queen’s University Belfast, Northern Ireland
| | - CJ Lockhart
- Department of Therapeutics and Pharmacology, Queen’s University Belfast, Northern Ireland
| | - A McCann
- Northern Ireland Medical Physics Agency, Belfast, Northern Ireland
| | - MT McHenry
- Lupus Research Group, Queen’s University Belfast, Northern Ireland
| | - RC McGivern
- Northern Ireland Medical Physics Agency, Belfast, Northern Ireland
| | - R Plumb
- Department of Therapeutics and Pharmacology, Queen’s University Belfast, Northern Ireland
| | - MB Finch
- Lupus Research Group, Queen’s University Belfast, Northern Ireland
| | - AL Bell
- Lupus Research Group, Queen’s University Belfast, Northern Ireland
| | - GE McVeigh
- Department of Therapeutics and Pharmacology, Queen’s University Belfast, Northern Ireland
| |
Collapse
|
45
|
Boffa JJ, Rougier JP, Noël N, Ronco P. [High cardiovascular complications in systemic lupus erythematosus: physiopathology and risk management]. Nephrol Ther 2009; 5:595-602. [PMID: 19733524 DOI: 10.1016/j.nephro.2009.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Revised: 06/19/2009] [Accepted: 06/20/2009] [Indexed: 10/20/2022]
Abstract
Today, cardiovascular mortality is the first cause of mortality in systemic lupus erythematosus (SLE). A 40-year-old woman with SLE is over 50 times more likely to have a myocardial infraction than a healthy woman of similar age. The high CV risk has a double origin: an early and progressive atherosclerosis and a prothrombotic propensity. Multiple factors are incriminated, including a higher prevalence of traditional CV risk factors in SLE population, as well as SLE-specific factors. Autoantibodies can modify lipid profile, induce tissue factor synthesis, favour clotting and endothelial apoptosis. Moreover, endothelial dysfunction and permanent chronic inflammation are present. Treatments are occasionally involved. To reduce more efficiently CV risk in SLE patients, we propose to consider SLE has a complete CV risk factor that should be implemented for CV risk management. This medical procedure of CV risk estimation is unusual in young patients. Its implementation in SLE patients requires a modification of medical practices. CV risk management in SLE patients include identification of optimal targets for each traditional risk factor and SLE specific treatments.
Collapse
Affiliation(s)
- Jean-Jacques Boffa
- Service de néphrologie et dialyses, hôpital Tenon, AP-HP, Paris, France.
| | | | | | | |
Collapse
|
46
|
Bhatt SP, Handa R, Gulati GS, Sharma S, Pandey RM, Aggarwal P, Ramakrishnan L, Shankar S. Atherosclerosis in Asian Indians with systemic lupus erythematosus. Scand J Rheumatol 2009; 35:128-32. [PMID: 16641047 DOI: 10.1080/03009740600557256] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Atherosclerosis has emerged as an important late complication of systemic lupus erythematosus (SLE). Asian Indians, as an ethnic group, are known to be metabolically predisposed to development of early atherosclerosis. No data on this aspect of SLE are available from Asia. This study was undertaken to find the frequency of atherosclerosis in Indian lupus patients and the factors affecting such an occurrence. METHODS Carotid artery intimo-medial thickness (IMT) and plaque were used as markers of atherosclerosis. High-resolution B-mode ultrasonography was used to compare carotid IMT and plaque in 50 patients with SLE and 50 age- and sex-matched healthy controls. RESULTS Patients with lupus (age 31.6+/-10.05, median 30.5 years; disease duration 52.3+/-36.7, median 46 months) exhibited a significantly greater IMT than controls (0.417+/-0.07 vs. 0.362+/-00.07 mm; p = 0.003). Carotid plaques were seen in seven (14%) cases. None of the control population had plaques (p = 0.006). On bivariate analysis, the IMT was significantly affected by age, systolic blood pressure (SBP), disease duration and menopausal status. On multivariate analysis, the only factor significantly affecting IMT was SBP. The Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR) score was the sole factor found to significantly affect the occurrence of plaque. CONCLUSIONS Asian Indian lupus patients in our study, despite being relatively young and with shorter disease duration, exhibited premature atherosclerosis in the form of significantly thicker intimo-media and plaque. The factors found to affect accelerated atherosclerosis in our cohort were age, SBP, disease duration, postmenopausal status and the SLICC/ACR score.
Collapse
Affiliation(s)
- S P Bhatt
- Department of Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | | | | | | | | | | | | |
Collapse
|
47
|
|
48
|
Hochman J, Urowitz MB, Ibañez D, Gladman DD. Hormone replacement therapy in women with systemic lupus erythematosus and risk of cardiovascular disease. Lupus 2009; 18:313-7. [PMID: 19276299 DOI: 10.1177/0961203308097475] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We sought to determine the impact of hormone replacement therapy (HRT) on the occurrence of coronary artery disease (CAD) in women with systemic lupus erythematosus (SLE). Women in the University of Toronto lupus database who had taken HRT with no history of CAD were compared with all post-menopausal female patients with no history of HRT or CAD. Chi-squared and t-tests were used to compare the risk factors of CAD and Kaplan-Meier curve, log rank test and proportional hazard model with time-dependent covariates were used to compare the time from entry into the clinic to occurrence of CAD. A total of 114 HRT-user patients with no history of CAD were compared with 227 post-menopausal non-HRT user SLE controls. The groups were similar with respect to lupus anticoagulant, antiphospholipid antibody, cumulative steroid dose and classic cardiac risk factors. A similar percentage of patients developed CAD in the control (13.7%) and HRT (11.4%) groups. There was no difference in the time to development of CAD. In the multivariate analysis, HRT was not a risk factor for CAD. Only age (P = 0.0001, HR = 1.11, 95% CI = 1.05, 1.17) and SLEDAI-2K (P = 0.0001, HR = 1.10, 95% CI = 1.05, 1.16) were significantly associated with the risk of CAD. In this small group of patients with SLE, HRT alone did not appear to predispose to CAD.
Collapse
Affiliation(s)
- J Hochman
- University of Toronto Lupus Clinic, Toronto Western Hospital, Toronto, Ontario, Canada
| | | | | | | |
Collapse
|
49
|
Alexandroff AB, Pauriah M, Camp RDR, Lang CC, Struthers AD, Armstrong DJ. More than skin deep: atherosclerosis as a systemic manifestation of psoriasis. Br J Dermatol 2009; 161:1-7. [PMID: 19500102 DOI: 10.1111/j.1365-2133.2009.09281.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
There is now growing evidence that psoriasis, like other inflammatory diseases such as rheumatoid arthritis and systemic lupus erythematosus, is a systemic disorder that is associated with enhanced atherosclerosis and risk of coronary artery disease. Here we summarize the available epidemiological evidence for this association and analyse pathogenic features that are common to psoriasis and atherosclerosis. Further prospective studies are urgently needed to extend knowledge of the risk of cardiovascular morbidity and mortality in patients with psoriasis and to confirm the degree to which treatment of psoriasis reduces this risk. Nevertheless, existing data are sufficient to indicate that severe psoriasis should be more widely recognized as a potential risk factor for cardiovascular disease and should be considered with the established factors when formulating strategies for the management of cardiovascular risk.
Collapse
Affiliation(s)
- A B Alexandroff
- Department of Dermatology, Leicester Royal Infirmary, Leicester LE1 5WW, UK.
| | | | | | | | | | | |
Collapse
|
50
|
Danila MI, Pons-Estel GJ, Zhang J, Vilá LM, Reveille JD, Alarcón GS. Renal damage is the most important predictor of mortality within the damage index: data from LUMINA LXIV, a multiethnic US cohort. Rheumatology (Oxford) 2009; 48:542-5. [PMID: 19233884 DOI: 10.1093/rheumatology/kep012] [Citation(s) in RCA: 144] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Damage accrual in SLE has been previously shown to be an independent predictor of mortality. We sought to discern which SLICC Damage Index (SDI) domains are the most important predictors of survival in SLE. METHODS SLE patients (ACR criteria), age > or =16 years, disease duration < or =5 years at enrolment, of African-American, Hispanic or Caucasian ethnicity were studied. Disease activity was assessed using the SLAM-Revised (SLAM-R) at diagnosis. Damage was ascertained using the SDI at the last visit. The SDI domains associated with time to death (and interaction terms) were examined by univariable and multivariable Cox proportional hazards regression analyses; those significant in the multivariable analyses were added to the final two models (with and without poverty) that included other variables known to be associated with shorter survival. RESULTS A total of 635 SLE patients were studied of whom 97 (15.3%) have died over a mean (s.d.) total disease duration of 5.7 (3.7) years. Patients were predominantly women [570 (89.8%)]; their mean (s.d.) age was 36.5 (12.6) years; 126 (19.8%) had developed renal damage, 62 (9.3%) cardiovascular, 48 (7.8%) pulmonary and 34 (5.4%) peripheral vascular damage. When excluding poverty from the multivariable model, the renal domain of the SDI was independently associated with a shorter time to death (hazard ratio = 1.65; 95% CI 1.03, 2.66). CONCLUSIONS The renal domain of the damage index is associated with a shorter time to death when poverty, a strong predictor of this outcome, is removed from the model. Preventing renal damage in lupus patients has long-term prognostic implications.
Collapse
Affiliation(s)
- Maria I Danila
- Department of Medicine, Division of Clinical Immunology and Rheumatology, School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | | | | | | | | | | |
Collapse
|