Prevalence of Atherosclerotic Vascular Disease in Cuban Patients With Systemic Lupus Erythematosus

Estévez del Toro, Miguel; Chico Capote, Araceli; Barahona Jorge, Roque Alejandro; Jiménez Paneque, Rosa; Hernández Castro, Jorge

doi:10.1016/S2173-5743(08)70144-8

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Atherosclerotic vascular disease-associated mortality and morbidity has increased in sick patients with systemic lupus erythematosus (SLE).

Objectives

To determine frequency of atherosclerotic vascular disease (AVD) in our patients, and to identify associations of some risk factors associated to its presence.

Method

Study included 51 patients and 51 controls paired by age, sex, and skin colour, who underwent carotid ultrasound (US) to measure thickness of the intima-medial complex, and to determine presence of plaques. In patients and controls we analyzed the presence of classic risk factors, eg, age, smoking, high blood pressure, diabetes mellitus, and hyperlipidemia. In addition in SLE we also analyzed the influencie on AVD of the clinical features of disease, as well as treatments applied.

Results

Risk factors were similar between patients and controls, except for hypertriglyceridemia, which was more frequent in patients. Presence of plaque was more prevalent in patients than in controls (59.9% vs 23.5%, P=.001). In multivariate analysis, age (OR, 1.31; 95% CI, 1.038–1.253; P=.005), diagnosis of SLE (OR, 3.872; 95% CI, 1.4–10.2; P=.005), and the presence of damage measured by SLICC/ACR (OR, 34.884; 95% CI, 1.1–12.9; P=.006) were the only variables independently associated to the presence of atherosclerosis in our patients.

Conclusions

Frequency of atherosclerosis is increased in patients presenting with SLE, risk factors independent of those classics, seem to be associated with this presence.

Key words:

Prevalence

Atherosclerotic vascular disease

Systemic lupus erythematosus

La morbimortalidad asociada a enfermedad vascular aterosclerótica ha aumentado en los enfermos con lupus eritematoso sistémico (LES).

Objetivos

Determinar la frecuencia con que se encuentra la enfermedad vascular aterosclerótica en nuestros pacientes, e identificar la asociación de algunos factores de riesgo con su presencia.

Método

El estudio incluyó a 51 pacientes y 51 controles identificados por edad, sexo y color de piel, a quienes se realizó ultrasonido de carótida para medir el grosor del complejo íntima-media y determinar la presencia de placa. Se identificaron, en pacientes y controles, los factores de riesgos clásicos, como edad, hábito tabáquico, hipertensión arterial, diabetes mellitus e hiperlipemia. En los pacientes con LES se analizaron además las características clínicas de la enfermedad y los tratamientos recibidos. Finalmente, se estudió la influencia de todas estas variables en la enfermedad vascular aterosclerótica de los pacientes con LES.

Resultados

Los factores de riesgo fueron similares entre pacientes y controles con la excepción de la hipertrigliceridemia más frecuente en los pacientes. La presencia de placa fue más prevalente en los pacientes que en los controles (el 56,9% frente al 23,5%, p=0,001). En el análisis multivariable, la edad (odds ratio [OR]=1,31; intervalo de confianza [IC] del 95%, 1,038–1,253; p=0,005), el diagnóstico de LES (OR=3,872; IC del 95%, 1,4–10,2; p=0,005) y el daño sistémico valorado por el índice de SLICC/ACR (OR=3,884; IC del 95%, 1,1–12,9; p=0,006) fueron las variables que de forma independiente se asociaron a la presencia de aterosclerosis en los pacientes con LES.

Conclusiones

La frecuencia de aterosclerosis se encuentra aumentada en los pacientes con LES, y parece que podría estar asociada a otros factores de riesgo independientes a los clásicamente implicados en la aterosclerosis.

Palabras clave:

Prevalencia

Aterosclerosis vascular

Lupus eritematoso sistémico

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References

[1.]

K.C. Kalunian.

Definition, classification activity in damage indice.

Dubois, Lupus Erythematosus, 5.a ed,

[2.]

S. Urdí, E.D. Harris, C.B. Sledge, T.C. Budd, J.S. Sergent.

Kelley's Textbook of Rheumatology.

6.a ed, Libros, (2003),

[3.]

K. Manger, B. Manger, R. Repp, M. Greisselbrecht, A. Greiger, A. Pfahlberg.

Definition of risk for death, in stage renal disease, and tromboembolicevents in a monocentric cohort of 338 patients with systemic lupus erythematosus.

Ann Rheum Dis, 6 (2002), pp. 1065-1070

[4.]

A.T. Borchers, C.L. Keen, Y. Shoenfeld, M.E. Gershwin.

Surviving the butterfly and the wolf: mortally trends in systemic lupus erythematosus.

Autoimmune Rev, 3 (2004), pp. 423-433

[5.]

Y. Alamanos, P.V. Voulgari, M. Papassava, K. Tsamandouraki, A.A. Drosos.

Survival and mortality rates of systemic lupus erythematosus in northwest Greece Study of 21 year incidence cohort.

Rheumatology (Oxford), 42 (2003), pp. 582-584

[6.]

K. Manger, M. Kusus, C. Forster, D. Ropers, W.G. Daniel, J.R. Kalden, et al.

Factor associated with coronary artery calcification in young female patients with SLE.

Ann Rheum Dis, 62 (2003), pp. 846-850

Medline

[7.]

C. Fienhn, Y. Hajjar, K. Mueller, R. Waldhern, A.D. Ho, K. Andrassy.

Improved clinical outcome of lupus nephritis during the past decade: Importance of early diagnosis and treatment.

Ann Rheum Dis, 62 (2003), pp. 435-439

Medline

[8.]

M.B. Urowitz, A.A. Bookman, B.E. Koehler, D.A. Gordon, H.A. Smythe, M.A. Ogryzlo.

The bimodal mortality pattern of systemic lupus erythematosus.

Am J Med, 60 (1976), pp. 221-225

Medline

[9.]

H. Johnson, O. Nived, G. Sturfelt.

Outcome in systemic lupus erythematosus: a prospective study of patients from a defined population.

Medicine (Baltimore), 68 (1989), pp. 141-150

[10.]

S. Manzi, E.N. Meilahn, J.E. Rairie, C.G. Conte, T.A. Medsger, J.R. Jansey-McWilliams, et al.

Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with Framingham study.

Am J Epidemiol, 145 (1997), pp. 408-415

Medline

[11.]

E. Svenungsson, K. Jensen-Ursatd, M. Heimburger, A. Silveira, A. Hamsten, V. de Faure, et al.

Risk factors for cardiovascular disease in systemic lupus erythematosus.

Circulation, 104 (2001), pp. 1887-1893

Article | Medline

[12.]

S. Manzi, F. Selzer, K. Sutton-Tyrrell, S.G. Fitzgerald, J.F. Raisie, R.P. Tracy, et al.

Prevalence and risk carotid plaque in women with systemic lupus erythematosus.

Arthritis Rheum, 42 (1999), pp. 51-60

http://dx.doi.org/10.1002/1529-0131(199901)42:1<51::AID-ANR7>3.0.CO;2-D | Medline

[13.]

M.J. Roman, J.E. Salmon, R. Sobel, M.D. Lockalin, L. Sammaritano, J.E. Schartz, et al.

Prevalence and relation to risk factors of carotid atherosclerosis and left ventricular hypertrophy in systemic lupus erythematosus and antiphospholipid antibody syndrome.

Am J Cardiol, 87 (2001), pp. 663-666

Medline

[14.]

A. Doria, Y. Shoenfield, P.F. Gambari.

Risk factors for subclinical atherosclerosis in a prospective cohort of patients with systemic lupus erythematosus.

Ann Rheum Dis, 62 (2003), pp. 1071-1077

Medline

[15.]

S. Jimenez, M.A. Garcia Criado, D. Tassies, J.C. Reverter, R. Cervera, M.R. Gilarbert, et al.

Preclinical vascular disease in systemic lupus erythematosus and primary antiphospholipid syndrome.

Rheumatology (Oxford), 41 (2005), pp. 756-761

[16.]

M. Petri, S. Perez-Gutthann, D. Spence, M.C. Hochberg.

Risk factors for coronary artery disease in patients with systemic lupus erythematosus.

Am J Med, 93 (1992), pp. 513-551

Medline

[17.]

M. Petri, D. Sepnce, L.R. Bone, M.C. Hochberg.

Coronary artery disease risk factors in the Johns Hopkins Lupus Cohort: prevalence, recognition by patients, and preventive practices.

Medicine (Baltimore), 71 (1992), pp. 291-302

[18.]

M. Petri, R. Roubenoff, G. Dallal, M.R. Nadeau, J. Selhub, I.H. Rosenberg.

Plasma homocysteine as a risk factor for atherothrombotic events in systemic lupus erythematosus.

Lancet, 348 (1996), pp. 1120-1124

http://dx.doi.org/10.1016/S0140-6736(96)03032-2 | Medline

[19.]

J.M. Esdaile, M. Abrahamowicz, T. Grodzicky, Y. Li, C. Panaritis, R. du Berger, et al.

Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus.

Arthritis Rheum, 44 (2001), pp. 2331-2337

Medline

[20.]

E. Svenungsson, I. Gunnarsson, G.Z. Fei, I.E. Lundberg, L. Klareskog, J. Frostegard.

Elevated triglycerides and low levels of high-density lipoprotein as markers of disease activity in association with up-regulation of the tumor necrosis factor alpha/tumor necrosis factor receptor system in systemic lupus erythematosus.

Arthritis Rheum, 48 (2003), pp. 2533-2540

http://dx.doi.org/10.1002/art.11264 | Medline

[21.]

L.J. Jara, G. Medina, O. Veral-Lastra, M.C. Amigo.

Accelerated atherosclerosis, immune response and autoimmune rheumatic diseases.

Autoimmun Rev, 5 (2006), pp. 195-201

http://dx.doi.org/10.1016/j.autrev.2005.06.005 | Medline

[22.]

Y. Shoenfeld, R. Gerli, A. Doria, E. Matsuura, M.M. Cerinic, N. Ronda, et al.

Accelerated atherosclerosis in autoimmune rheumatic diseases.

Circulation, 112 (2005), pp. 3337-3347

http://dx.doi.org/10.1161/CIRCULATIONAHA.104.507996 | Medline

[23.]

E.M. Tan, A.S. Cohen, J.F. Fries, A.T. Masi, D.J. Mcslave, N.F. Rothfield, et al.

The 1982 revised criteria for the classification of systemic lupus erythematosus.

Arthritis Rheum, 25 (1982), pp. 1271-1277

Medline

[24.]

A.W. Souza, F.S. Hatta, F. Fa Miranda Jr., I.E. Sato.

[Atherosclerosis plaque in carotid arteries in systemic lupus erythematosus: frequency and associated risk factors.].

Sao Paulo Med J, 123 (2005), pp. 45-48

[25.]

N.I. Bruce.

Not only. but also: factors that contribute to accelerat atherosclerosis and premature coronary heart disease in systemic lupus erythematosus.

Rheumatology, 44 (2005), pp. 1492-1502

http://dx.doi.org/10.1093/rheumatology/kei142 | Medline

[26.]

D.E. Laaksonen, H.M. Lakka, NiskanenLK, G.A. Kaplan, J.T. Salonen, T.A. Lakka.

Metabolic syndrome and development of diabetes mellitus: application and validation of recently suggested definitions of the metabolic syndrome in a prospective cohort study.

Am J Epidemiol, 156 (2002), pp. 1070-1077

Medline

[27.]

M.J. Roman, B.A. Shanker, A. Davis.

Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus.

N Engl J Med, 349 (2003), pp. 2399-2406

http://dx.doi.org/10.1056/NEJMoa035471 | Medline

[28.]

Y. Asanuma, A. Oeser, A.K. Shintani, E. Turner, N. Olsen, S. Fozio, et al.

Premature coronary atherosclerosis in systemic lupus erythematosus.

N Engl J Med, 349 (2003), pp. 2407-2415

http://dx.doi.org/10.1056/NEJMoa035611 | Medline

[29.]

T. Wolak, E. Todosoui, G. Szendro, A. Bolotin, B.S. Jonathan, D. Flusser, et al.

Duplex study of the carotid and femoral arteries of patients with systemic lupus erythematosus.

J Rheumatol, 31 (2004), pp. 909-914

Medline

[30.]

F. Selzer, K. Sutton-Tyrrell, S.G. Fitzgerald, J.E. Pratt, R.P. Tracy, L.H. Kuller, et al.

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

Arthritis Rheum., 50 (2004), pp. 151-159

http://dx.doi.org/10.1002/art.11418 | Medline

[31.]

S.P. Bhatt, R. Handa, G.S. Gulati, S. Shamun, R.M. Paudey, P. Aggorwald, et al.

Atherosclerosis in Asian Indians with systemic lupus erythematosus.

Scand J Rheumatol, 35 (2006), pp. 128-132

http://dx.doi.org/10.1080/03009740600557256 | Medline

[32.]

F. Falaschi, A. Ravelli, A. Martignoni, D. Miglivacca, M. Sartori, A. Pistorio, et al.

Nephrotic range proteinuria, the major risk factor for early atherosclerosis in juvenile-onset systemic lupus erythematosus.

Arthritis Rheum, 43 (2000), pp. 1405

http://dx.doi.org/10.1002/1529-0131(200006)43:6<1405::AID-ANR26>3.0.CO;2-V | Medline

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