Assessment of Coronary Risk Based on Cumulative Exposure to Lipids in Systemic Lupus Erythematosus

Nikpour, Mandana; Gladman, Dafna D.; Ibañez, Dominique; Harvey, Paula; Urowitz, Murray B.

doi:10.3899/jrheum.121273

Cited by 6 publications

(3 citation statements)

References 20 publications

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“…Higher levels of total cholesterol and low-density lipoprotein cholesterol have been associated with a higher risk of MI and stroke in SLE 74 78 83. One study using national administrative data found that patients with SLE treated with lipid-lowering agents had a significantly lower risk of coronary artery disease during follow-up (mean 8.4 years) than those not treated, while short-duration or long-duration statin use were both associated with a lower risk of stroke 84.…”

Section: Resultsmentioning

confidence: 99%

EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome

et al. 2022

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ObjectiveTo develop recommendations for cardiovascular risk (CVR) management in gout, vasculitis, systemic sclerosis (SSc), myositis, mixed connective tissue disease (MCTD), Sjögren’s syndrome (SS), systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS).MethodsFollowing European League against Rheumatism (EULAR) standardised procedures, a multidisciplinary task force formulated recommendations for CVR prediction and management based on systematic literature reviews and expert opinion.ResultsFour overarching principles emphasising the need of regular screening and management of modifiable CVR factors and patient education were endorsed. Nineteen recommendations (eleven for gout, vasculitis, SSc, MCTD, myositis, SS; eight for SLE, APS) were developed covering three topics: (1) CVR prediction tools; (2) interventions on traditional CVR factors and (3) interventions on disease-related CVR factors. Several statements relied on expert opinion because high-quality evidence was lacking. Use of generic CVR prediction tools is recommended due to lack of validated rheumatic diseases-specific tools. Diuretics should be avoided in gout and beta-blockers in SSc, and a blood pressure target <130/80 mm Hg should be considered in SLE. Lipid management should follow general population guidelines, and antiplatelet use in SLE, APS and large-vessel vasculitis should follow prior EULAR recommendations. A serum uric acid level <0.36 mmol/L (<6 mg/dL) in gout, and disease activity control and glucocorticoid dose minimisation in SLE and vasculitis, are recommended. Hydroxychloroquine is recommended in SLE because it may also reduce CVR, while no particular immunosuppressive treatment in SLE or urate-lowering therapy in gout has been associated with CVR lowering.ConclusionThese recommendations can guide clinical practice and future research for improving CVR management in rheumatic and musculoskeletal diseases.

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Section: Resultsmentioning

confidence: 99%

EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome

et al. 2022

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“…Hyperlipidaemia is associated with adverse cardiovascular outcomes in SLE4 6 7; however, it is often unrecognised and undermanaged 8–11. The recent EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases (RMDs)4 state that lipid management in SLE should follow general population guidelines.…”

Section: Introductionmentioning

confidence: 99%

Lipid management in systemic lupus erythematosus according to risk classifiers suggested by the European Society of Cardiology and disease-related risk factors reported by the EULAR recommendations

et al. 2023

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BackgroundThe European Alliance of Associations for Rheumatology recommended that lipid-lowering therapy (LLT) in systemic lupus erythematosus (SLE) should follow general population guidelines. We examined the eligibility for LLT in SLE according to Systematic Coronary Risk Evaluation (SCORE), with and without the addition of vascular ultrasound (VUS) and disease-related features.Methods210 patients with SLE without prior cardiovascular events, diabetes or antiphospholipid syndrome underwent cardiovascular risk assessment with SCORE. LLT eligibility was evaluated in low-risk and moderate-risk patients following European Society of Cardiology (ESC) guidelines. Atherosclerotic plaques on carotid ultrasound (cUS)) and carotid and femoral ultrasound (cfUS), prolonged disease duration (PDD, ≥10 years), failure to achieve lupus low disease activity state (LLDASno), cumulative glucocorticoid ‘cardiovascular harm’ dose (GCCVH, optimal cut-off to predict ultrasound-detected plaques) and antiphospholipid antibody positivity (aPLpos) were tested as SCORE risk enhancers for classification ability (phi coefficient) and agreement (Cohen’s kappa) using SCORE plus cfUS as a reference modality for LLT eligibility.ResultsPlaques were detected in 9.9% of low-risk cases and 54.6% of moderate-risk cases. SCORE alone would indicate 0% of low-risk patients and 3% of moderate-risk patients for LLT eligibility. According to SCORE+cfUS, 9.9% of low-risk patients and 57.6% of moderate-risk patients, respectively, would be eligible for LLT based on ESC guidelines. Ιn low-risk/moderate-risk patients, phi values for SCORE+PDD, GCCVH(cut-off ≥11 g), LLDASnoand aPLposin antiplatelet-naïve antiphospholipid antibody-positive (aPLpos/APT−) cases were 0.06/0.13, 0.23/0.20, 0.07/0.16 and 0.06/0.33, respectively. Agreement for LLT eligibility to SCORE+cfUS was better for SCORE+PDD in moderate-risk patients and for SCORE+cUS in both groups of patients. SCORE+GCCVH and SCORE+aPLposshowed at least fair agreement (kappa ≥0.20) to SCORE+cfUS in low-risk or moderate-risk and in aPLpos/APT− moderate-risk patients, respectively.ConclusionDisease-related and VUS features, in addition to SCORE, may help to improve LLT decision making in SLE. GCCVHand aPLposimprove LLT eligibility similarly and to a greater degree than PDD or LLDASno.

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“…Triglycerides and cholesterol are both lipids that circulate in the bloodstream and are escorted through the blood vessels by lipoproteins. Indeed, lipids have a direct effect on coronary events in lupus patients (Nikpour et al, 2013). The lipid profile in lupus patients is characterized by increased total cholesterol and triglycerides and this lupus associated dyslipidemia is well-documented (Ortiz et al, 2013).…”

Section: Introductionmentioning

confidence: 99%

Altered renal immune complexes deposition in female BWF1 lupus mice following Plasmodium chabaudi infection

Abdel-Maksoud

Abdel-Ghaffar

Elamir

et al. 2018

Saudi Journal of Biological Sciences

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Systemic lupus erythematosus (SLE) is a prototypic autoimmune disease that has a mysterious relationship with malaria infection. The current study was designated to compare between the effect of the live and the gamma irradiated Plasmodium chabaudi infection on BWF1 lupus murine model. A total of 30 female BWF1 mice were randomly divided into three groups (10 mice/group) as follows: group (I) lupus group (lupus non infected); group (II) live malaria infected group (lupus + live malaria infection); and group (III) irradiated malaria-infected group (lupus + gamma irradiated malaria infection). Live P. chabaudi infection was accompanied with a decrease in survival rate and food consumption in comparison to the control group of mice while gamma irradiated P. chabaudi -infection was unable to do this effect. Additionally, live P. chabaudi infection was accompanied with an increased level of proteinuria and increased rate of immune complexes deposition in kidney. Moreover, infection with live, but not gamma-irradiated P. chabaudi was accompanied with an increase in nitric oxide (NO), hydrogen peroxide (H2O2), and malondialdehyde (MDA) levels in plasma of lupus mice. The levels of both total cholesterol and triglycerides in plasma of lupus mice after live P. chabaudi infection were obviously decreased in comparison to the control group. On the other hand, gamma-irradiated P. chabaudi infection resembled the control group. Our data revealed that infection of lupus mice with live but not gamma-irradiated P. chabaudi has several histological and biochemical effects.

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Assessment of Coronary Risk Based on Cumulative Exposure to Lipids in Systemic Lupus Erythematosus

Abstract: This study links LDL-C, TC:HDL-C ratio, and TG to coronary risk in patients with SLE and quantifies the magnitude of this risk. SLE-specific risk assessment levels for lipids may be selected to optimize positive or negative predictive values.

Cited by 6 publications

References 20 publications

EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome

EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome

Lipid management in systemic lupus erythematosus according to risk classifiers suggested by the European Society of Cardiology and disease-related risk factors reported by the EULAR recommendations

Altered renal immune complexes deposition in female BWF1 lupus mice following Plasmodium chabaudi infection

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