Серцево-судинні захворювання (ССЗ) внаслідок раннього атеросклерозу є провідною причиною смертності у хворих на системний червоний вовчак (СЧВ), що не можна повністю пояснити традиційними факторами ризику ССЗ, прийомом глюкокортикоїдів (ГК) й активністю запального процесу. Жінки віком 35-44 роки, хворі на СЧВ, мають у 50 разів більший ризик ін-фаркту міокарда порівняно зі здоровими жінками [1]. Ранній атеросклероз у 6 разів частіше спостерігається у хворих на СЧВ порівняно із загальною популяцією [2]. Однак клітинні і молекулярні механізми, що лежать в основі раннього атеросклерозу при СЧВ, досі не є пов ністю визначеними [3]. Маркером раннього атеросклерозу вважається ендотеліальна дисфункція (ЕД)потенційно оборотна втрата нормальної судинної ре
Objective: Early-onset atherosclerosis with cardiovascular (CV) sequelae is the major cause of death in systemic lupus erythematosus (SLE); that cannot be explained only by traditional Framingham risk factors as SLE-related factors may also have an impact. The present study aimed to analyze the determinants of atherosclerosis development and risk factors modification by statin therapy in SLE patients. Design and method: This prospective randomized study included 100 SLE patients aged 40.9±1.4 years (90 females, 10 males) and 32 age-, sex-matched healthy controls. Brachial artery flow-mediated dilation (FMD), ultrasound of extracranial and peripheral arteries, and cardiac calcium scoring were used for the identification of atherosclerosis. 52 SLE patients with dyslipidemia were randomized to receive simvastatin 40 mg/day (n = 27) or placebo (n = 25). Lipid panel, FMD, and inflammatory markers were assessed at baseline and after 6 months. Results: The mean duration of SLE was 9.9±0.88 years. The disease activity index (SLEDAI) and SLE damage score (SLICC) were 11.8±0.6 and 1.85±0.13 points, respectively. In 66% of SLE patients, atherosclerosis was present in at least one vascular area which was 3.5 times more frequently compared with controls. Atherosclerosis of carotid arteries was detected in 41% of SLE patients, lower limb arteries, and coronary arteries in 58% and 39% of patients, respectively. FMD was significantly decreased in SLE patients compared to controls (7.95±0.49% vs 11.6±0.3%, p<0.001). In multiple linear regression, age (p<0.001), nephritis (p = 0.001), polyarthritis (p = 0.019), and Raynaud's syndrome (p = 0.045) were associated with low FMD. In binary logistic regression, independent determinants of the atherosclerosis development in SLE were age (p<0.001), body mass index (BMI) (p = 0.001), anti-dsDNA (p = 0.023), FMD (p = 0.017) and malar rash (p = 0.02). After simvastatin treatment, the level of LDL-Cholesterol reduced by 42%, erythrocyte sedimentation rate, C-reactive protein, and interleukin-6 decreased by 34.7%, 51.1%, and 47.7% respectively, while FMD increased by 26.0% (p<0.05); in the placebo group, there were no significant changes. Conclusions: The independent determinants of atherosclerosis in SLE patients were both traditional CV risk factors (age, BMI) and SLE-specific factors (anti-dsDNA, malar rash, FMD). In SLE patients with dyslipidemia, simvastatin may have not only lipid-lowering but also potentially anti-inflammatory benefits.
Objectives study frequency and nature of atherosclerotic damage of extracranial arteries (ECA), coronary arteries (CA), leg arteries (LA) and associated symptoms in patients (pts) with systemic lupus erythematosus (SLE). Methods Study included 100 pts with SLE (90 women and 10 men) aged 18 - 66 (mean 40,9±1,4) with disease history of 1 - 43 years (mean 9.93±0.88 years). All pts underwent duplex ultrasound (DU) of carotid, vertebral, iliac, femoral, popliteal and tibial arteries and abdominal aorta. Atherosclerosis(AS) was confirmed if intima-media thickness (IMT) was ≥0,8 mm or atherosclerotic plaques (AP) were present. Multidetector computed tomography (MDCT) was used for CA calcification detection, and the result was regarded as positive when calcium index exceeded 10. The control group (CG) consisted of 32 apparently healthy pts (26 women and 6 men, mean age 38,4±2,4 years). Results AS in ECA was found in 41 (41%) SLE pts, and this incidence was 3.3-fold higher vs CG. 9 pts had IMT increase only, 17 – IMT increase in combination with AP, 15 - AP and normal IMT. AP were found in the common carotid (27 pts) and internal carotid (17 pts) arteries, but not in the vertebral arteries. 37,5% of pts with AP in ECA had artery narrowing up to 50% (none with >50% narrowing). Clinical symptoms that could be associated with AS of cerebral arteries (includingTIA/strokes) were present in 63,4% of pts with ECA AS. LA AS symptoms were found in 58 (58%) pts- 3.7-fold higher incidence vs CG. 3 pts had IMT increase only, 21 – IMT increase with AP, 34 - AP and normal IMT.AP were visualized in all the examined areas of LA, most often, in tibial arteries (40% pts), and almost twice as less in the abdominal aorta, common femoral and popliteal arteries. Isolated damage of LA distal areas was present 2.7 times more often vs proximal.41,8% of pts with AP presented 10% to total occlusion stenosis, 18,2% - >50% stenosis. Clinical symptoms that could be associated with hypoperfusion of the leg were found in 79,3% pts with LA AS, while critical stenosis/occlusion of the arteries was present in all pts with intermittent claudication. CA calcification was found in 39 (39%) pts - 4.2-fold higher incidence vs CG. Most often, AP were located in the left main artery (66,7% from 39) and left anterior descending artery (51,3%), more rarely – in the left circumflex (12,8%) and right CA (10,3%). Clinical symptoms of the ischemic heart disease were presented by 11 pts: effort angina – 10, old myocardial infarction – 6, 5 of whom had angina pectoris. In general, AS, at least in one system of artery, was found in 66,0% pts. LA AS incidence was higher vs ECA (p <0.05) and CA (p <0.01). Isolated damage of one system of artery was observed in 31,8% of pts, two systems - 27.3% (in all cases involving LA), all three systems - 40,9%. Most often, AS was found in one artery (21,2%), and all other pts had 2 – 11 (mean – 4) arteries affected. Conclusions High AS incidence (66%), which is 3,5-fold higher than in apparently healthy people, is typical for SLE...
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