Comparison of risk factors for vascular disease in the carotid artery and aorta in women with systemic lupus erythematosus

Abstract

Objective. To examine and compare risk factors for various stages of subclinical vascular disease in different vascular beds (carotid and aorta) in women with systemic lupus erythematosus (SLE) who have not yet developed clinical cardiovascular disease.Methods. This cross-sectional study was conducted in 214 women without clinical cardiovascular disease who were enrolled in the Pittsburgh Lupus Registry. B-mode ultrasound was used to measure carotid plaque and intima-media wall thickness (IMT). Doppler probes were used to collect pulse-wave velocity waveforms from the right carotid and femoral arteries as a measure of aortic stiffness. All risk factor data were collected on the day of the ultrasound examinations.Results. The mean ؎ SD age of the women was 45.2 ؎ 10.5 years and the median SLE disease duration was ϳ9 years. Sixty-eight (32%) of the women had at least 1 focal plaque. The mean ؎ SD IMT was 0.71 ؎ 0.1 mm, and the mean ؎ SD pulse-wave velocity was 5.96 ؎ 1.6 meters/second. Using logistic regression, we found that determinants of plaque included older age, higher systolic blood pressure, lower levels of high-density lipoprotein 3, and antidepressant use. Determinants of plaque severity were older age, higher systolic blood pressure, lower levels of albumin, and smoking. Independent determinants of the highest quartile of IMT were older age, higher pulse pressure, lower levels of albumin, elevated C-reactive protein levels, high cholesterol, and higher levels of glucose. Higher aortic stiffness was associated with older age, higher systolic blood pressure, higher C3 levels, lower white blood cell count, higher insulin levels, and renal disease.Conclusion. In women with SLE, the risk factors associated with carotid plaque and IMT are those typically associated with cardiovascular disease in the general population, whereas the risk factors associated with vascular stiffness include SLE-specific variables related to immune dysregulation and complement metabolism. The high prevalence of cardiovascular disease among lupus patients may result from both early adverse effects on vascular stiffening as well as later promotion of wall thickening and plaque through inflammatory-mediated processes. These observations provide clues for future mechanistic studies.Systemic lupus erythematosus (SLE) affects primarily women and causes chronic vascular inflammation. Women with SLE, particularly those under age 45 years, experience higher than expected rates of clinical cardiovascular disease, i.e., hypertension (1-3), myocardial infarction (1,4), and stroke (4). In addition to traditional cardiovascular risk factors, other factors specifically associated with SLE appear to be equally, if not more, important (5,6). It is likely that these factors are related to the underlying immune-mediated, inflammatory processes inherent in SLE.Although the pathogenesis of vascular disease in SLE is unknown, it is thought to be multifactorial and of atherosclerotic origin. Atherosclerosis involves both atherosis (fatty degeneration) an...

White blood cell subsets are associated with carotid intima-media thickness and pulse wave velocity in an older Chinese population: the Guangzhou Biobank Cohort Study

“…23 However, it is possible that the opposite counterintuitive direction of the association in the previous contradictory study reflected the sample from which participants were drawn, who were women with systemic lupus erythematosus, making comparison with our study difficult. Our WBC count finding appeared to be accounted for mainly by granulocyte number, supported by our positive association between granulocyte number and PWV.…”

“…22 In contrast, in a sample of women with systemic lupus erythematosus, higher aortic stiffness, measured by carotid-femoral PWV, was associated with a lower WBC count. 23 No studies have examined this relationship in an older Chinese population, and, as far as we are aware, no studies have examined associations between sub-types of leukocyte and PWV. In Chinese populations, atherosclerosis is thought to be highly prevalent and is associated with CVD risk factors, including blood pressure, plasma glucose and low-density lipoproteins cholesterol.…”

Whole blood viscosity and arterial thrombotic events in patients with systemic lupus erythematosus

“…Despite a high level of scientific interest in blood rheology and cardiovascular disease in the general population, little work has focused on the role of rheologic variables in lupus, a disease characterized by premature atherothrombotic events (6,7,34,35). Because traditional risk factors do not fully explain the high rate of atherosclerotic disease in patients with SLE, nontraditional risk factors warrant greater scrutiny.…”

Increased expression of markers of early atherosclerosis in patients with inflammatory bowel disease

“…Atherogenesis is a chronic inflammatory process of the arterial wall, finally leading to endothelial dysfunction [10,11], which involves the alteration of the control of the vascular tone, leukocytes trafficking and platelets adhesion. The risk of early onset of atherosclerosis is well known in individuals suffering from other chronic inflammatory disorders such as rheumatoid arthritis and systemic lupus erythematosus [12][13][14], thus it should not be surprising that, in the last decade, an increasing body of data, both epidemiological and clinical, have supported this association also in IBD.…”