Early Vascular Alterations in SLE and RA Patients—A Step towards Understanding the Associated Cardiovascular Risk

Abstract

Accelerated atherosclerosis represents a major problem in both systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) patients, and endothelial damage is a key feature of atherogenesis. We aimed to assess early endothelial changes in SLE and RA female patients (127 SLE and 107 RA) without previous CV events. Biomarkers of endothelial cell activation (intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), thrombomodulin (TM), and tissue factor (TF)) were measured and endothelial function was assessed using peripheral artery tonometry. Reactive hyperemia index (RHI), an indicator of microvascular reactivity, and augmentation index (AIx), a measure of arterial stiffness, were obtained. In addition, traditional CV risk factors, disease activity and medication were determined. Women with SLE displayed higher sICAM-1 and TM and lower TF levels than women with RA (p = 0.001, p<0.001 and p<0.001, respectively). These differences remained significant after controlling for CV risk factors and medication. Serum levels of vascular biomarkers were increased in active disease and a moderate correlation was observed between sVCAM-1 levels and lupus disease activity (rho = 0.246) and between TF levels and RA disease activity (rho = 0.301). Although RHI was similar across the groups, AIx was higher in lupus as compared to RA (p = 0.04). Also in active SLE, a trend towards poorer vasodilation was observed (p = 0.06). In conclusion, women with SLE and RA present with distinct patterns of endothelial cell activation biomarkers not explained by differences in traditional CV risk factors. Early vascular alterations are more pronounced in SLE which is in line with the higher CV risk of these patients.

Serum angiopoietin-2

“…In the present work, the mean levels of serum Ang-2 serum levels were elevated in all SLE patients (with and without nephritis), compared with healthy controls which agreed with those described previously [9,21], they found that Ang-2 was significantly elevated in SLE patients. Moreover the current work showed that, serum Ang-2 levels were significantly higher in patients with LN than in those without nephritis.…”

Involvement of TLR4 in Oxidized LDL/β2GPI/Anti-β2GPI-Induced Transformation of Macrophages to Foam Cells

“…Recently, it has been shown that early vascular alterations and endothelial cell activation biomarkers are more pronounced in patients with SLE, which is in line with the high cardiovascular risks observed in such patients 33) . An elevated level of whole blood TF procoagulant correlates with the increased formation of β2GPI/anti-β2GPI complexes in monocytes.…”

Calciphylaxis induced by warfarin therapy in a patient with anti-phospholipid antibody syndrome associated with systemic lupus erythematosus

“…Before our patient showed calciphylaxis symptoms, she was diagnosed with SLE and APS. Autoimmune diseases lead to endothelial damage [7]. SLE patients, especially those with APS, tend to have arterial calcification [8].…”