Subclinical atherosclerosis in systemic lupus erythematosus patients and its relationship to disease activity and damage indices

Fadda, Samia H.; Nassar, Hanan R.; Gamal, Sherif M.; Al-Azizi, H.

doi:10.1007/s00393-014-1473-1

Cited by 6 publications

(5 citation statements)

References 33 publications

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“…The higher SLEDAI score in our young patients along with the higher values of hsCRP in sera and high percent of patients with positive antibodies (although nonsignificant vs older patients) suggests a more accented immune-mediated inflammatory component within the SLE vasculopathy. These parameters in numerous studies have been recognized as significant SLE-related risk factors for atherogenesis [8,9,10,11]. Moreover, an additional risk-factor in our young patients for atherosclerosis were identified -the higher percent of patients with positive aPhL antibodies and LAC, which may complicate the atherosclerosis increasing the risk of developing antiphospholipide syndrome, thrombogenesis, and thromboembolism.…”

Section: Discussionmentioning

confidence: 73%

“…Such a risk profile in young patients requires more aggressive treatment of the underlying disease, which was proved in the study -unlike the older patient, the young patients more often were treated aggressively with more than 2 and/or 3 anti SLE medications, besides regular therapy with corticosteroids (CS). Overall, these SLE related factors of atherogenesis -high SLEDAI score and hsCRP, the type of anti SLE medications, less aggressive treatment with CS) alone, poor disease control, are distinguished in a number of studies as specific risk factors and promoters for atherosclerosis [8][9][10][11][12][13] in contrast to high-dose CS therapy, multidrug treatment of SLE, specifically chloroquine and hydrochloroquine, which give good control of the disease, especially the anti-inflammatory component, acting atheroprotective [14].…”

Section: Discussionmentioning

confidence: 99%

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Myocardial Perfusion Abnormalities in Young and Premenopausal Women with Systemic Lupus Erythematosus, Detected with 99MTC MIBI Myocardial Perfusion Scintigraphy – Prevalence and Correlation with Proatherogenic Factors

Sandevska

Gjorcheva

Vavlukis

et al. 2018

Prilozi

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Introduction: Atherosclerosis in young and premenopausal women with systemic lupus erythematosus (SLE) is frequent, premature and progressive. Although asymptomatic or with atypical clinical presentation, the patients are at high risk of cardiac events. Aim of this study is to estimate the risk profile for atherogenesis and the prevalence of myocardial perfusion abnormalities with 99mTc myocardial perfusion scintigraphy (MPS) in young and premenopausal women. Material and methods: Sixty female patients, aged 30-72 years (divided into two subgroups - patients under 45 years of age and patients over 45 years), diagnosed with SLE for over of 5 years, in active phase of the disease were analyzed for disease activity scores (SLEDAI), the immunologic status of the disease (ANA and a-DNA antibodies in the serum), procoagulant tendency (antiphospholipid antibodies-APhL and lupus-anticoagulant-LAC), the activity of the inflammatory process (hsCRP), the anti-SLE therapeutic approach and the presence of traditional risk factors for atherosclerosis (BMI, smoking, hypertension, hyperlipidemia, diabetes, and familial history for the CAD). Using one-day Dipyridamol – Rest 99mTc SPECT Gated MPS SPECT the extent, severity and reversibility of myocardial perfusion abnormalities were estimated, along with summed scores at stress, rest and summed difference scores and left ventricle volumes and ejection fraction. Results: Abnormal MPS SPECT were detected in 27/60 or in 45% of patients, with one vessel affection of 66.7% (18/27pts) of LAD and 14.8% (4/27pts) o RCA and with two vessel disease of LAD/RCA in 2/27 pts (7.4%) and LAD/Cx in 3/27pts (11.1%). Myocardial perfusion abnormalities were equally prevalent in subgroups of patients younger than 45 years (44,4%) and in patients older than 45 years (45.5%) (ns). The subgroups did not differ significantly concerning the extent of perfusion abnormalities (9,8±3.2% of LV myocardial mass vs. 9,8±7.1%,ns), their severity (with predominance of mild perfusion defects, 48,6% vs. 51,3%,ns) and reversibility (reversible in 41.3% and 58.6%, ns). The differences between the summed scores of severity and the extent of ischemia in the two subgroups were statistically nonsignificant. Younger patients had significantly higher end-diastolic, end-systolic and stroke volumes during stress and rest conditions, compared to older patients (p<0,01) although there were no differences in systolic function, which was not affected in either of the groups as expressed threw ejection fraction. Although nonsignificant, younger patients had higher values of hsCRP and higher procoagulant activity (positive aPhL, LAC) while they were with more active disease activity, with higher SLEDAI score compared to older patients (p=0.028). Higher SLEDAI score and LV volumes, especially EDV at stress were identified as predictor of abnormal MPS in younger groups and more aggressive multidrug anti SLE treatment as predictor of normal MPS. Conclusion: The prevalence and characteristics of myocardial perfusion abnormalities in young SLE are equal as the same in older SLE patients, which indicates the presence of premature, accelerated atherosclerosis in young cohort of patients with SLE. Younger SLE patients with pure disease control (higher SLEDAI score, less aggressive treatment, high hsCRP values and pronounced procoagulant tendency) should undergo screening for myocardial perfusion abnormalities s using 99mTc MIBI MPS)

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Myocardial Perfusion Abnormalities in Young and Premenopausal Women with Systemic Lupus Erythematosus, Detected with 99MTC MIBI Myocardial Perfusion Scintigraphy – Prevalence and Correlation with Proatherogenic Factors

Sandevska

Gjorcheva

Vavlukis

et al. 2018

Prilozi

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“…The current study has some unique features, which are different from previous studies13–15 17 18 24 First, to the best of our knowledge, most related previous studies were from Europe or North America, they comprised mostly Caucasian people, and some of the previous evidence was secondary analysis of data from placebo-controlled clinical trials with a short follow-up time. This study is the first prospective cohort to monitor CIMT in Chinese patients with SLE.…”

Section: Discussionmentioning

confidence: 85%

“…Traditional Framingham risk factors, including age, sex, hyperlipidemia, smoking, hypertension and C reactive protein, partly explain, but do not account entirely, for the increased incidence of premature atherosclerosis in patients with SLE 10–13. Recent studies have shown that factors related to SLE, medication, psychological stress and novel non-traditional factors, such as inflammation, are likely to contribute to development of premature atherosclerosis 14–21. Most studies have established an association between risk factors and accelerated atherosclerosis on the basis of frequency of myocardial infarction, stroke or cardiovascular deaths among patients with SLE 22 23.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for progression of carotid intima-media thickness in patients with systemic lupus erythematosus: protocol for an observational cohort study in China

Pang

Ding

et al. 2019

BMJ Open

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IntroductionAccelerated atherosclerosis is a major complication of systemic lupus erythematosus (SLE), and it leads to increased cardiovascular morbidity and mortality in patients with SLE. This study aimed to investigate the natural progression of carotid intima-media thickness (CIMT), and to examine the risk factors for progression of CIMT and atherosclerotic plaques based on a Chinese SLE cohort.Methods and analysisParticipants were continuously enrolled as outpatients of the Department of Rheumatology in Peking Union Medical College Hospital (PUMCH) from October 2013 to December 2016. Inclusion criteria were as follows: (1) age ≥18 years, (2) fulfilment of clinical classification criteria of SLE and (3) provision of signed written informed consent. Patients with clinically overt coronary artery disease, a history of cardiovascular disease (previous stroke, heart failure, myocardial infarction, angina or symptomatic peripheral artery disease) and malignancy, and pregnant/lactating women were excluded. The primary outcome is progression of CIMT from baseline. A total of 440 patients with SLE will be enrolled. Participants will receive follow-up surveys ~5 years after their baseline visit. A standard structural survey form, including demographic data, medical history, clinical and laboratory assessments and CIMT measurement, is planned for data collection at baseline and follow-up. The risk prediction model for progression of CIMT will be created by using a mixed effect model.Ethics and disseminationThe study protocol was approved by the institutional review board of PUMCH (S-599). Informed consent was obtained from all participants according to the Declaration of Helsinki on Biomedical Research Involving Human Studies. All data will be managed confidentially according to guidelines and legislation. Dissemination will include publication of scientific papers and/or presentations of the study findings at international conferences.

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“…In last decades, cIMT measurement has demonstrated to be a good predictor for cardiovascular events in SLE population vs CS based mainly on increased cIMT and the presence of plaques [2], also as a tool to look for early atherosclerosis, even the heterogeneity between number of segments, wall characteristics, uni or bilateral evaluation besides dependent or independent operator B mode ultrasound [26–28]. Some reports with less than 30 SLE cases, associated increase cIMT with steroid use, ESR, TG, TC, HDLc, SLEDAI, SLICC, urine protein concentration in 24 hours, ATH and aging [29].…”

Section: Discussionmentioning

confidence: 99%

Subclinical parameters of arterial stiffness and arteriosclerosis correlate with QRISK3 in systemic lupus erythematosus

et al. 2018

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It is well known that cardiovascular diseases (CVD) are a major contributor of death in systemic lupus erythematosus (SLE) as well in other rheumatic illness. In the last decades, there has been a growing development of different methodologies with the purpose of early detection of CVD. Objective: The aim of this study is to correlate the usefulness of subclinical parameters of vascular aging and QRISK 3–2017 score for early detection of CVD in SLE. Methods: Clinical assessment including systemic lupus erythematosus disease activity index (SLEDAI) and systemic lupus international collaborating clinics / american college of rheumatology damage index (SLICC/ACR DI), laboratory measurements, carotid ultrasound examination, carotid intima media thickness (cIMT) measurement, carotid distention and diameter analysis, arterial stiffness measurement measured by tonometry and QRISK 3–2017 were done. All results were analyzed by SPSS 24 software. Results: We observed correlation between QRISK3 and mean cIMT (rs = 0.534, P < 0.001), PWV (rs = 0.474, P < 0.001), cfPWV (rs = 0.569, P < 0.001) and distensibility (rs = -0.420, P = 0.006). Consistent with above, SLE patients in middle and high risk QRISK 3–2017 showed increased arterial stiffness versus low risk group. Conclusions: We encourage to the rheumatology community to assess cardiovascular risk in SLE patients with QRISK 3–2017 risk calculator as an alternative method at the outpatient clinic along a complete cardiovascular evaluation when appropriate.

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Subclinical atherosclerosis in systemic lupus erythematosus patients and its relationship to disease activity and damage indices

Abstract: Subclinical atherosclerosis is frequent in SLE patients. Increased disease activity and damage are associated with the occurrence of premature atherosclerosis.

Cited by 6 publications

References 33 publications

Myocardial Perfusion Abnormalities in Young and Premenopausal Women with Systemic Lupus Erythematosus, Detected with 99MTC MIBI Myocardial Perfusion Scintigraphy – Prevalence and Correlation with Proatherogenic Factors

Myocardial Perfusion Abnormalities in Young and Premenopausal Women with Systemic Lupus Erythematosus, Detected with 99MTC MIBI Myocardial Perfusion Scintigraphy – Prevalence and Correlation with Proatherogenic Factors

Risk factors for progression of carotid intima-media thickness in patients with systemic lupus erythematosus: protocol for an observational cohort study in China

Subclinical parameters of arterial stiffness and arteriosclerosis correlate with QRISK3 in systemic lupus erythematosus

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