1
|
Hamijoyo L, Putri M, Alita VR, Atik N, Syamsunarno MRA. Fatty acid binding protein 4 (FABP4) and metabolic-related parameters in systemic lupus erythematosus active and non-active episode. Lupus 2021; 30:1133-1139. [PMID: 33840283 DOI: 10.1177/09612033211006908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess serum FABP4 and other metabolic-related parameters in Systemic Lupus Erythematosus (SLE) active and non-active episode. METHODS Fifty-four SLE patients in Hasan Sadikin General Hospital, Bandung, Indonesia in 2018-2019 were recruited and serum samples were collected in their active and non-active episode status. Serum was analyzed for FABP4, leptin, glucose, and triglycerides. The clinical characteristics were analyzed from medical records. Disease activity was assessed with the SLEDAI-2K (≥4 defined as an active; <4 as non-active episode). RESULTS Significantly correlation of Systolic Blood Pressure (SBP) (p = 0.001, r = 0.59) and C3 (p = 0.04, r = 0.47) between active and non-active episode. In non-active episode, there was significant correlation of FABP4 with Diastolic Blood Pressure (DBP) (p = 0.04, r = 0.26) and blood glucose (p = 0.01, r = -0.39). In active episode, there was significant correlation FABP4 with SBP (p = 0.04, r = -0.28) and triglyceride (p = 0.002, r = 0.55). CONCLUSION FABP4 correlates with high DBP in the non-active and high triglyceride serum in the active episode.
Collapse
Affiliation(s)
- Laniyati Hamijoyo
- Rheumatology Division, Department of Internal Medicine, Faculty of Medicine Universitas Padjadjaran, Hasan Sadikin General Hospital, Bandung, Indonesia.,Lupus Study Group, Immunology Study Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Mirasari Putri
- Lupus Study Group, Immunology Study Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Department of Biochemistry, Nutrition, and Biomolecular, Faculty of Medicine Universitas Islam Bandung, Bandung, Indonesia
| | - Vilya Rizkiyanti Alita
- Lupus Study Group, Immunology Study Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Nur Atik
- Lupus Study Group, Immunology Study Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| | - Mas Rizky Aa Syamsunarno
- Lupus Study Group, Immunology Study Centre, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia.,Department of Biomedical Sciences, Faculty of Medicine, Universitas Padjadjaran, Bandung, Indonesia
| |
Collapse
|
2
|
Ganjali S, Shirmohammadi L, Read MI, Sahebkar A. High-density lipoprotein functionality in systemic lupus erythematosus. Semin Arthritis Rheum 2020; 50:769-775. [PMID: 32531506 DOI: 10.1016/j.semarthrit.2020.05.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 11/18/2022]
Abstract
Systemic lupus erythematosus (SLE) is a heterogeneous disease which is characterized with excessive inflammation and autoantibodies, macrophage and complement activation, and subsequently immunologically mediated tissue damage. In spite of improved treatments of SLE, these patients experience premature atherosclerosis and the rate of mortality among them remains high. Autoantibodies and circulating immune complexes might contribute to the pathogenesis of atherosclerosis by injuring the endothelium, as well as inducing pro-inflammatory and pro-adhesive endothelial cell phenotypes, as well as altering the metabolism of lipoproteins involved in atherogenesis. Hence, high levels of atherogenic lipoproteins (like low-density lipoprotein (LDL) and very low-density lipoprotein (VLDL)) and low levels of high-density lipoprotein (HDL-C) are important risk factors for atherosclerotic cardiovascular complications in SLE patients but these traditional risk factors fail to fully explain the increased risk of cardiovascular disease (CVD) in these patients. The exact mechanism by which inflammation decreases HDL levels is not defined, but decreases in apoA-I production and lecithin cholesterol acyltransferase (LCAT) activity, as well as increased serum amyloid A (SAA), endothelial lipase and secretory phospholipase A2 activity (PLA2) could all contribute. In addition, during inflammation multiple changes in HDL structure occur, leading to alterations in HDL function which may be implicated in the CVD complications of SLE. Therefore, this review will aim to identify the mechanisms implicated in HDL dysfunction which occurs in SLE patients.
Collapse
Affiliation(s)
- Shiva Ganjali
- Department of Medical Biotechnology & Nanotechnology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Leila Shirmohammadi
- Department of Medical Biotechnology & Nanotechnology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Morgayn I Read
- Department of Pharmacology, University of Otago School of Medical Sciences, Dunedin, New Zealand
| | - Amirhossein Sahebkar
- Halal Research Center of IRI, FDA, Tehran, Iran; Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran; Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
| |
Collapse
|
3
|
Wu K, Wen L, Duan R, Li Y, Yao Y, Jing L, Jia Y, Teng J, He Q. Triglyceride Level Is an Independent Risk Factor in First-Attacked Neuromyelitis Optica Spectrum Disorders Patients. Front Neurol 2019; 10:1230. [PMID: 31824407 PMCID: PMC6881454 DOI: 10.3389/fneur.2019.01230] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 11/05/2019] [Indexed: 12/17/2022] Open
Abstract
Objective: To investigate prospective associations between triglyceride (TG) level and prognosis of first-attacked patients with neuromyelitis optica spectrum disorders (NMOSD). Methods: This retrospective study included 196 patients newly diagnosed with NMOSD from June 2014 to December 2018. Data of clinical parameters, including age of onset, sex, BMI, blood lipid levels, anti-aquaporin-4 status, serum glucose level, therapy regimens, comorbidities, initial Expanded Disability Status Scale (EDSS), relapses, and outcomes were collected. We used logistic regression models to examine the associations among relevant clinical factors and outcomes, and statistical analyses were performed using the SPSS 23.0 software. Results: Compared with the high TG group, residual EDSS was relatively lower in the normal TG group (median 1.0 vs. 2.0, P = 0.002). In the univariate analysis, TG level was positively correlated with outcomes (OR 1.75, 95% CI 1.18-2.60, P = 0.005) and relapses (OR 1.57, 95% CI 1.07-2.31, P = 0.02). Our stratified analysis suggested that patients with normal BMI (OR 4.90, 95% CI 2.10-11.44, P = 0.001) were closely correlated with poor recovery owing to increased TG level. In the multivariate analysis, a statistically significant association still existed between TG level and outcomes (OR 3.44, 95% CI 1.02-11.64; P = 0.040) after adjusting for various variables. Conclusions: In first-attacked NMOSD patients, TG level was positively associated with poor recovery. Early monitoring and treatment of elevated TG level in NMOSD patients are important.
Collapse
Affiliation(s)
- Kaimin Wu
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - LuLu Wen
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ranran Duan
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanfei Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yaobing Yao
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Lijun Jing
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanjie Jia
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junfang Teng
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Qianyi He
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| |
Collapse
|
4
|
Ferreira HB, Pereira AM, Melo T, Paiva A, Domingues MR. Lipidomics in autoimmune diseases with main focus on systemic lupus erythematosus. J Pharm Biomed Anal 2019; 174:386-395. [DOI: 10.1016/j.jpba.2019.06.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/31/2019] [Accepted: 06/04/2019] [Indexed: 01/03/2023]
|
5
|
Bagchi S, Genardi S, Wang CR. Linking CD1-Restricted T Cells With Autoimmunity and Dyslipidemia: Lipid Levels Matter. Front Immunol 2018; 9:1616. [PMID: 30061888 PMCID: PMC6055000 DOI: 10.3389/fimmu.2018.01616] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 06/29/2018] [Indexed: 11/13/2022] Open
Abstract
Dyslipidemia, or altered blood lipid content, is a risk factor for developing cardiovascular disease. Furthermore, several autoimmune diseases, including systemic lupus erythematosus, psoriasis, diabetes, and rheumatoid arthritis, are correlated highly with dyslipidemia. One common thread between both autoimmune diseases and altered lipid levels is the presence of inflammation, suggesting that the immune system might act as the link between these related pathologies. Deciphering the role of innate and adaptive immune responses in autoimmune diseases and, more recently, obesity-related inflammation, have been active areas of research. The broad picture suggests that antigen-presenting molecules, which present self-peptides to autoreactive T cells, can result in either aggravation or amelioration of inflammation. However, very little is known about the role of self-lipid reactive T cells in dyslipidemia-associated autoimmune events. Given that a range of autoimmune diseases are linked to aberrant lipid profiles and a majority of lipid-specific T cells are reactive to self-antigens, it is important to examine the role of these T cells in dyslipidemia-related autoimmune ailments and determine if dysregulation of these T cells can be drivers of autoimmune conditions. CD1 molecules present lipids to T cells and are divided into two groups based on sequence homology. To date, most of the information available on lipid-reactive T cells comes from the study of group 2 CD1d-restricted natural killer T (NKT) cells while T cells reactive to group 1 CD1 molecules remain understudied, despite their higher abundance in humans compared to NKT cells. This review evaluates the mechanisms by which CD1-reactive, self-lipid specific T cells contribute to dyslipidemia-associated autoimmune disease progression or amelioration by examining available literature on NKT cells and highlighting recent progress made on the study of group 1 CD1-restricted T cells.
Collapse
Affiliation(s)
| | | | - Chyung-Ru Wang
- Department of Microbiology and Immunology, Northwestern University, Chicago, IL, United States
| |
Collapse
|
6
|
Durcan L, Winegar DA, Connelly MA, Otvos JD, Magder LS, Petri M. Longitudinal Evaluation of Lipoprotein Variables in Systemic Lupus Erythematosus Reveals Adverse Changes with Disease Activity and Prednisone and More Favorable Profiles with Hydroxychloroquine Therapy. J Rheumatol 2016; 43:745-50. [PMID: 26834214 DOI: 10.3899/jrheum.150437] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Systemic lupus erythematosus (SLE) is associated with accelerated atherosclerotic cardiovascular disease. Patients with SLE have adverse lipoprotein variables, but little is known about how these change with treatment and disease activity. The nuclear magnetic resonance LipoProfile test contains a glycoprotein signal-termed GlycA, an inflammatory marker, which has not been evaluated in SLE. We assessed patients longitudinally to determine how lipoproteins and GlycA change with active SLE. METHODS Sera from selected clinical visits of patients in the Hopkins Lupus Cohort were analyzed for lipoprotein and GlycA levels. Univariate and multivariate analyses were performed to evaluate lipoprotein variables and their relationship to ethnicity, disease activity, prednisone use, and hydroxychloroquine (HCQ) therapy. RESULTS Fifty-two patients were included over 229 visits. Adverse changes in lipoprotein variables with disease activity were demonstrated. For each point increase in the Systemic Lupus Erythematosus Disease Activity Index, there was a decrease in high-density lipoprotein (HDL) even after adjusting for corticosteroid use. Prednisone was associated with higher very low-density lipoprotein, low-density lipoprotein, HDL, and triglycerides. HCQ was associated with more favorable variables. GlycA levels were higher than in normal populations and increased with disease activity. CONCLUSION Adverse changes in lipoprotein profiles were associated with SLE activity and prednisone therapy. This gives insight into mechanisms of atherosclerosis in SLE. Favorable lipoprotein variables occurred in those taking HCQ. GlycA increased with disease activity and was higher than in healthy populations.
Collapse
Affiliation(s)
- Laura Durcan
- From the Johns Hopkins University School of Medicine, Baltimore; Department of Epidemiology and Public Health, University of Maryland, College Park, Maryland; LipoScience, Laboratory Corporation of America Holdings, Raleigh, North Carolina, USA.L. Durcan, MD, Johns Hopkins University School of Medicine; D.A. Winegar, PhD, LipoScience, Laboratory Corporation of America Holdings; M.A. Connelly, PhD, MBA, LipoScience, Laboratory Corporation of America Holdings; J.D. Otvos, PhD, LipoScience, Laboratory Corporation of America Holdings; L.S. Magder, MPH, PhD, Department of Epidemiology and Public Health, University of Maryland; M. Petri, MD, MPH, Johns Hopkins University School of Medicine.
| | - Deborah A Winegar
- From the Johns Hopkins University School of Medicine, Baltimore; Department of Epidemiology and Public Health, University of Maryland, College Park, Maryland; LipoScience, Laboratory Corporation of America Holdings, Raleigh, North Carolina, USA.L. Durcan, MD, Johns Hopkins University School of Medicine; D.A. Winegar, PhD, LipoScience, Laboratory Corporation of America Holdings; M.A. Connelly, PhD, MBA, LipoScience, Laboratory Corporation of America Holdings; J.D. Otvos, PhD, LipoScience, Laboratory Corporation of America Holdings; L.S. Magder, MPH, PhD, Department of Epidemiology and Public Health, University of Maryland; M. Petri, MD, MPH, Johns Hopkins University School of Medicine
| | - Margery A Connelly
- From the Johns Hopkins University School of Medicine, Baltimore; Department of Epidemiology and Public Health, University of Maryland, College Park, Maryland; LipoScience, Laboratory Corporation of America Holdings, Raleigh, North Carolina, USA.L. Durcan, MD, Johns Hopkins University School of Medicine; D.A. Winegar, PhD, LipoScience, Laboratory Corporation of America Holdings; M.A. Connelly, PhD, MBA, LipoScience, Laboratory Corporation of America Holdings; J.D. Otvos, PhD, LipoScience, Laboratory Corporation of America Holdings; L.S. Magder, MPH, PhD, Department of Epidemiology and Public Health, University of Maryland; M. Petri, MD, MPH, Johns Hopkins University School of Medicine
| | - James D Otvos
- From the Johns Hopkins University School of Medicine, Baltimore; Department of Epidemiology and Public Health, University of Maryland, College Park, Maryland; LipoScience, Laboratory Corporation of America Holdings, Raleigh, North Carolina, USA.L. Durcan, MD, Johns Hopkins University School of Medicine; D.A. Winegar, PhD, LipoScience, Laboratory Corporation of America Holdings; M.A. Connelly, PhD, MBA, LipoScience, Laboratory Corporation of America Holdings; J.D. Otvos, PhD, LipoScience, Laboratory Corporation of America Holdings; L.S. Magder, MPH, PhD, Department of Epidemiology and Public Health, University of Maryland; M. Petri, MD, MPH, Johns Hopkins University School of Medicine
| | - Laurence S Magder
- From the Johns Hopkins University School of Medicine, Baltimore; Department of Epidemiology and Public Health, University of Maryland, College Park, Maryland; LipoScience, Laboratory Corporation of America Holdings, Raleigh, North Carolina, USA.L. Durcan, MD, Johns Hopkins University School of Medicine; D.A. Winegar, PhD, LipoScience, Laboratory Corporation of America Holdings; M.A. Connelly, PhD, MBA, LipoScience, Laboratory Corporation of America Holdings; J.D. Otvos, PhD, LipoScience, Laboratory Corporation of America Holdings; L.S. Magder, MPH, PhD, Department of Epidemiology and Public Health, University of Maryland; M. Petri, MD, MPH, Johns Hopkins University School of Medicine
| | - Michelle Petri
- From the Johns Hopkins University School of Medicine, Baltimore; Department of Epidemiology and Public Health, University of Maryland, College Park, Maryland; LipoScience, Laboratory Corporation of America Holdings, Raleigh, North Carolina, USA.L. Durcan, MD, Johns Hopkins University School of Medicine; D.A. Winegar, PhD, LipoScience, Laboratory Corporation of America Holdings; M.A. Connelly, PhD, MBA, LipoScience, Laboratory Corporation of America Holdings; J.D. Otvos, PhD, LipoScience, Laboratory Corporation of America Holdings; L.S. Magder, MPH, PhD, Department of Epidemiology and Public Health, University of Maryland; M. Petri, MD, MPH, Johns Hopkins University School of Medicine
| |
Collapse
|
7
|
Fernández-Nebro A, Marenco JL, López-Longo F, Galindo M, Hernández-Cruz BE, Narváez J, Rúa-Figueroa ÍI, Raya-Alvarez E, Zea A, Freire M, Sánchez-Atrio AI, García-Vicuña R, Pego-Reigosa JM, Manrique-Arija S, Nieves-Martín L, Carreño L. The effects of rituximab on the lipid profile of patients with active systemic lupus erythematosus: results from a nationwide cohort in Spain (LESIMAB). Lupus 2014; 23:1014-22. [DOI: 10.1177/0961203314534909] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction Patients with systemic lupus erythematosus (SLE) have increased cardiovascular risk related to lipid changes induced by inflammatory activity, proteinuria and treatments. Our objective was to analyse lipid changes in a cohort of patients with SLE resistant to standard treatments who were treated with rituximab. Methods The study population comprised a retrospective multicentre, national cohort of patients with SLE resistant to standard treatments who were treated with rituximab. The basic lipid profile, concomitant treatment and disease activity were analysed at the start of the treatment, 24 weeks later, and at the end of the follow-up period. The effects of the main lupus variables and therapy on the lipid changes were analysed. Results Seventy-nine patients with active lupus treated with rituximab were assessed during 149.3 patient-years. Prior to the treatment, 69% had dyslipidaemia. The most frequent abnormalities were a low-density lipoprotein (LDL) level of ≥100 mg/dl (34%) and a high-density lipoprotein (HDL) level of <50 mg/dl (27%). Baseline total cholesterol (TC) and LDL levels correlated with the degree of proteinuria, while the concentration of triglycerides (TGs) correlated with the SLE Disease Activity Index (SLEDAI). TGs were reduced at short- and long-term follow-up after rituximab treatment. A multiple linear regression analysis identified that the reduction of the lupus inflammatory activity, particularly changes in proteinuria, was the only independent variable that was positively associated with the reduction in TGs after 24 weeks ( p = 0.001) and with TC ( p = 0.005) and TGs ( p < 0.001) at the end of the follow-up period. Conclusion Our results suggest that rituximab may improve the long-term lipid profile of patients with SLE refractory to standard treatment, mainly by reducing inflammatory activity.
Collapse
Affiliation(s)
- A Fernández-Nebro
- UGC Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, Spain
| | - JL Marenco
- Hospital Virgen de Valme, Rheumatology Department, Sevilla, Spain
| | - F López-Longo
- Hospital General Universitario Gregorio Marañón, Rheumatology Department, Madrid, Spain
| | - M Galindo
- Hospital Universitario 12 de Octubre, Rheumatology Department, Madrid, Spain
| | | | - J Narváez
- Hospital Universitario de Bellvitge, Rheumatology Department, Hospitalet de Llobregat, Barcelona, Spain
| | - Í I Rúa-Figueroa
- Hospital Universitario de Gran Canaria Dr Negrín, Rheumatology Department, Las Palmas de Gran Canaria, Spain
| | - E Raya-Alvarez
- Hospital Clínico Universitario San Cecilio, Rheumatology Department, Granada, Spain
| | - A Zea
- Hospital Universitario Ramón y Cajal, Rheumatology Department, Madrid, Spain
| | - M Freire
- Complejo Hospitalario Universitario A Coruña, Rheumatology Department, A Coruña, Spain
| | - AI Sánchez-Atrio
- Hospital Universitario Príncipe de Asturias, Rheumatology Department, Alcalá de Henares, Madrid, Spain
| | - R García-Vicuña
- Hospital Universitario de la Princesa, Rheumatology Department, Madrid, Spain
| | - JM Pego-Reigosa
- Complejo Hospitalario Universitario de Vigo, Rheumatology Department, Hospital del Mexoeiro, Instituto de Investigación Biomédica de Vigo (IBIV), Vigo, Spain
| | - S Manrique-Arija
- UGC Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, Spain
| | - L Nieves-Martín
- UGC Reumatología, Instituto de Investigación Biomédica de Málaga (IBIMA), Hospital Regional Universitario de Málaga/Universidad de Málaga, Málaga, Spain
| | - L Carreño
- Hospital General Universitario Gregorio Marañón, Rheumatology Department, Madrid, Spain
| | | |
Collapse
|
8
|
CHONG YIPBOON, YAP DESMONDYH, TANG COLINSO, CHAN TAKMAO. Dyslipidaemia in patients with lupus nephritis. Nephrology (Carlton) 2011; 16:511-7. [DOI: 10.1111/j.1440-1797.2011.01456.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
9
|
Skamra C, Ramsey-Goldman R. Management of cardiovascular complications in systemic lupus erythematosus. ACTA ACUST UNITED AC 2010; 5:75-100. [PMID: 20305727 DOI: 10.2217/ijr.09.73] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Patients with SLE have an excess risk compared with the general population; this is particularly pronounced in younger women with SLE who have an excess risk of over 50-fold compared with population controls. There is a higher prevalence of subclinical atherosclerosis in patients with SLE compared with controls, as demonstrated by a variety of imaging modalities discussed in this review. The causality of the excess risk of CVD and subclinical atherosclerosis is multifactorial in patients with SLE. While traditional risk factors play a role, after controlling for the traditional Framingham risk factors, the excess risk is still 7.5-fold greater than the general population. This review will also cover novel cardiovascular risk factors and some SLE-specific variables that contribute to CVD risk. This review discusses the risk factor modification and the evidence available for treatment of these risk factors in SLE. There have not yet been any published randomized, controlled trials in patients with SLE with respect to CVD risk factor modifications. Thus, the treatment and management recommendations are based largely on published guidelines for other populations at high risk for CVD.
Collapse
|