Nuclear Magnetic Resonance Lipoprotein Subclasses and the APOE Genotype Influence Carotid Atherosclerosis in Patients with Systemic Lupus Erythematosus

Abstract

Lipoprotein subclasses are more associated with subclinical atherosclerosis in patients with SLE than the lipid variables that are routinely measured. The IDL fraction, which is significantly modulated by the APOE genotype, is the most strongly, significantly, and positively correlated with IMT.

Longitudinal Evaluation of Lipoprotein Variables in Systemic Lupus Erythematosus Reveals Adverse Changes with Disease Activity and Prednisone and More Favorable Profiles with Hydroxychloroquine Therapy

“…Gonzalez et al (9) previously evaluated NMR lipid parameters in SLE at a single point in time. They found that chylomicrons, VLDL (total, large, medium and small) and LDL (very small and small, but not large) were associated with carotid intima medial thickness.…”

“…The conventional lipid abnormalities typically reported in SLE are elevated triglycerides (TG) and low high-density lipoprotein cholesterol (HDL-C) (5, 6). Routine lipid measurements do not distinguish between lupus and normal controls, nor do they help identify lupus patients with atherosclerosis (7-9). However, conventional lipid parameters seem to worsen with disease activity.…”

“…NMR lipoprotein analysis revealed that SLE patients have larger very low density lipoprotein (VLDL) particles and lower levels of large HDL compared to controls (18). Further, in SLE, with established atherosclerosis based on carotid intimal medial thickness, very small, small and medium LDL and IDL particle numbers were higher (9), suggesting pathogenicity. Changes in lipoproteins with disease activity longitudinally have not been evaluated.…”

Patients With Systemic Lupus Erythematosus Show an Increased Arterial Stiffness That is Predicted by IgM Anti–β2‐Glycoprotein I and Small Dense High‐Density Lipoprotein Particles

“…Our group has focused on research regarding surrogate markers of subclinical atherosclerosis in SLE patients and a more detailed method to analyze the lipid profile by nuclear magnetic resonance (NMR), because standard laboratory methods did not reflect the real atherogenic lipid profile in these patients (27)(28)(29). We have also observed that some specific SLE-related factors, such as complement system factors and antiphospholipid antibodies (aPL), are also associated with carotid IMT thickness and some lipoproteins measured by NMR, such as intermediatedensity lipoprotein (IDL) particles and small dense high-density lipoprotein (HDL) particles (30,31).…”

Subclinical Atherosclerosis in Systemic Autoimmune Disorders

“…Apart from HDL, LDL can be also modified in SLE; Frostergard et al disclosed higher levels of oxidized epitopes on LDL in lupus patients compared to controls, which were associated with arterial disease and renal manifestations (Frostegard, Svenungsson et al 2005). In a recent study, circulating lipoprotein remnant particles and the intermediate density lipoprotein (IDL) fraction have been strongly associated with IMT values in lupus patients (Gonzalez, Ribalta et al 2010). Furthermore, reduced levels of apoA-I -the major apolipoprotein component of HDL-have been found in SLE patients with IgG anticardiolipin antibodies (Delgado Alves, Kumar et al 2003) while antibodies to apoA-I have been previously documented in 32.5% of patients with SLE and 22.9% of patients with primary antiphospholipid syndrome (Dinu, Merrill et al 1998).…”