Risk Factors for Cardiovascular Disease in Systemic Lupus Erythematosus

Department of Rheumatology and Centre for Molecular Medicine, King Gustaf V Research Institute, Karolinska Hospital, Stockholm, Sweden.
Circulation (Impact Factor: 14.43). 10/2001; 104(16):1887-93. DOI: 10.1161/hc4101.097518
Source: PubMed


Cardiovascular disease (CVD) is overrepresented in patients with systemic lupus erythematosus (SLE). We determined the prevalence of traditional and nontraditional risk factors for CVD in SLE patients with and without CVD compared with controls.
Twenty-six women (aged 52+/-8.2 years) with SLE and a history of CVD (SLE cases) were compared with 26 age-matched women with SLE but without manifest CVD (SLE controls) and 26 age-matched population-based control women (population controls). Common carotid intima-media thickness (IMT) was measured by B-mode ultrasound as a surrogate measure of atherosclerosis. SLE cases had increased IMT compared with SLE controls (P=0.03) and population controls (P=0.001), whereas IMT of SLE controls did not differ from population controls. SLE cases had raised plasma concentrations of circulating oxidized LDL (OxLDL; P=0.03), as measured by the monoclonal antibody EO6, and autoantibodies to epitopes of OxLDL (P<0.001); dyslipidemia with raised triglycerides (P<0.001) and lipoprotein(a) (P=0.002) and decreased HDL-cholesterol concentrations (P=0.03); raised alpha-1-antitrypsin (P=0.002), lupus anticoagulant (P=0.007), and homocysteine levels (P=0.03); more frequent osteoporosis (P=0.03); and a higher cumulative prednisolone dose (P=0.05) compared with SLE controls. Disease duration, smoking, blood pressure, body mass index, and diabetes mellitus did not differ significantly between the groups.
alpha set of distinct CVD risk factors separate SLE cases from SLE controls and population controls. If confirmed in a prospective study, they could be used to identify SLE patients at high risk for CVD in order to optimize treatment.


Available from: Elisabet Svenungsson, Sep 28, 2015
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    • "Because of its chronic nature, unpredictable course and widespread potential for harm, these patients have a shorter life expectancy and reduced quality of life compared to healthy sedentary population (Tench et al. 2002). Although physical activity can prevent long-term consequences of SLE such as obesity, osteoporosis and premature cardiovascular and cerebrovascular diseases risk (Petri et al. 1992; Svenungsson et al. 2001; Bruce et al. 2003; Oeser et al. 2005; Goldberg et al. 2009; Gustafsson et al. 2009; Urowitz et al. 2008; Volkmann et al. 2010), in John Hopkins Lupus Cohort, 70% of patients reported a sedentary lifestyle (Petri et al. 1992). Although physical activity reduces the patients' fear of disability, there is still a great difference of opinion about the time of onset, type and intensity of that activity. "
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    ABSTRACT: Given the crucial events in systemic lupus erythematosus (SLE) such as joint and muscle pain, fatigue, depression, obesity and osteoporosis, the very thought of exercising can be challenging. This prospective study included 60 patients diagnosed with SLE in stable condition. A randomly selected group of 30 women had aerobic training on a bicycle ergometer for a period of 15 minutes, 3 times per week for 6 weeks, while the second group of 30 women performed isotonic exercises (to stretch and lengthen muscles and improve the range of motion) for 30 minutes, 3 times per week during the same period. Fatigue Severity Scale (FSS), Short Form 36 (SF36) questionnaire on the quality of life and Beck depression inventory (BDI) were analyzed at baseline and after 6 weeks. At baseline FSS score was 53.8 ± 5.7 and after the physical activity FSS score was 29.1 ± 7.8 (FSS ≥ 36; fatigue is present). The largest number of patients (66.7%) was in a moderate depressed state at the baseline, while after physical activities 61.7% of patients, had a mild mood disturbance. There were significant differences (p < 0.001) in values of all areas of quality of life questionnaire SF36 before and after the implementation of physical activity. The type of physical activity had no influence in FSS and BDI values. Continuous physical activity, regardless of its type, significantly improved quality of life of SLE patients. We recommend regular physical activity as an integral part of modern therapeutic approach in this patient population.
    The Tohoku Journal of Experimental Medicine 07/2015; 237(3):193-199. DOI:10.1620/tjem.237.193 · 1.35 Impact Factor
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    • "The crucial role of inflammatory mechanisms in the progression of atherosclerosis has promoted many studies focusing on whether diseases characterized by chronic inflammation, including inflammatory bowel disease (IBD), carry an increased risk of cardiovascular disease [6] [7]. Numerous previous studies have reported an increased incidence of stroke and myocardial infarction (MI) in patients with rheumatoid arthritis, psoriasis, and systemic lupus erythematosus [8] [9] [10], but studies on the risk of atherothrombotic disease among patients with IBD are inconclusive [11] [12] [13] [14] [15]. However, recent evidence showed that IBD is associated with an increased risk of stroke and MI [16] [17]. "
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    ABSTRACT: Background and aims: This cohort study assessed the association between inflammatory bowel disease (IBD) and the risk of future ischemic stroke. Methods: The IBD cohort comprised adult patients (≥ 20years old) who had received either ambulatory or inpatient care between 1998 and 2011 and IBD-free controls were randomly selected from the general population and frequency matched according to age, sex, and index year (included 18,392 patients with IBD and 73,568 control patients). Both cohorts with ischemic stroke before the index date and the ischemic stroke cases diagnosed within one year after the index date were excluded. We observed the study patients until the incidence of ischemic stroke, death, withdrawal from the insurance program, or they were lost to follow-up, or the end of 2011. Results: The risk of ischemic stroke was 1.12-fold (95% CI, 1.02-1.23) higher among the IBD cohort than among the non-IBD cohort. Compared to the subjects without IBD, the adjusted HR of ischemic stroke was 1.15 (95% CI 1.04-1.28) in the Crohn's disease (CD) patients and 1.01 (95% CI 0.84-1.21) in the ulcerative colitis (UC) group. The risk of developing ischemic stroke significantly increased with the increased frequency of IBD exacerbation and hospitalization. Furthermore, the adjusted HR among the CD patients increased in conjunction with the number of medical visits, from 1.07 to 6.36 and the adjusted HR among the UC patients also increased in conjunction with the number of medical visits, from 1.11 to 2.10. Conclusions: IBD exhibited an increased risk of developing ischemic stroke.
    European Journal of Internal Medicine 06/2014; 25(6). DOI:10.1016/j.ejim.2014.05.009 · 2.89 Impact Factor
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    • "However, the results do not appear to be translated to human disease. While the cross-reactivity between antibodies against cardiolipin (a phospholipid species) and ox-LDL might imply an increased chance of the development of CVD in patients with SLE, the association between anti-ox-LDL antibodies and CVD remains inconsistent in these patients [67, 108, 109]. On the other hand, the association between antiphospholipid antibodies and CVD is undoubtedly clear. "
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    ABSTRACT: Atherosclerosis is accelerated in patients with systemic lupus erythematosus (SLE) and it leads to excessive cardiovascular complications in these patients. Despite the improved awareness of cardiovascular disease and advent of clinical diagnostics, the process of atherogenesis in most patients remains clinically silent until symptoms and signs of cardiovascular complications develop. As evidence has demonstrated that vascular damage is already occurring before clinically overt cardiovascular disease develops in lupus patients, intervention at the preclinical stage of atherogenesis would be plausible. Indeed, endothelial dysfunction, one of the earliest steps of atherogenesis, has been demonstrated to occur in lupus patients even when they are naïve for cardiovascular disease. Currently known "endothelium-toxic" factors including type 1 interferon, proinflammatory cytokines, inflammatory cells, immune complexes, costimulatory molecules, neutrophils extracellular traps, lupus-related autoantibodies, oxidative stress, and dyslipidemia, coupled with the aberrant functions of the endothelial progenitor cells (EPC) which are crucial to vascular repair, likely tip the balance towards endothelial dysfunction and propensity to develop cardiovascular disease in lupus patients. In this review, altered physiology of the endothelium, factors leading to perturbed vascular repair contributed by lupus EPC and the impact of proatherogenic factors on the endothelium which potentially lead to atherosclerosis in lupus patients will be discussed.
    03/2014; 2014:178721. DOI:10.1155/2014/178721
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