Non-invasive assessment of endothelial dysfunction in pre-menopausal systemic lupus erythematosus women at risk of atherosclerosis

ABSTRACT

To assess the endothelial dysfunction in patients with SLE by measuring endothelial reactivity in pre-menopausal female patients at risk of atherosclerosis without traditional cardiovascular risk factors. This study was conducted on 30 pre-menopause SLE patients and 25 age and sex- matched volunteers. All the patients and controls were free of traditional cardiovascular risk factors. We examined the endothelial function by brachial artery FMV, assessed by high resolution non-invasive ultrasound, where the diameter of the brachial artery is measured at rest and after reactive hyperaemia. The FMV of the brachial artery [endothelium dependent response] was significantly lower in patients than in control subjects [4.1 +/- 1.3 v13.2 +/- 2.0%; p<0.001]. Comparing the FMV with the different variables of the patients' group, we did not find any significant correlation between FMV and; patients' age, disease duration, systolic and diastolic blood pressure, Raynaud's phenomenon, vasculitis and ESR. While, there was a strongly significant difference in brachial artery FMV seen between 12 [40%] aCL positive patients compared to 18 [60%] patients with aCL negative and when compared with controls [4.0 +/- 0.7 v 11.3 +/- 0.6]%, p <0.001; 4.0 +/- 0.7 v 13.2 +/- 2.0%, p<0.001 respectively]. There was also a strongly positive correlation between SLEDAI disease activity score and baseline diameter and FMV [rs=0.42, p<0.001; rs= 0.44, p<0.001 respectively]. While there was a weakly positive statistical difference between FMV and the CRP [rs=-0.24, p=0.05]. The baseline value of FMV showed an inverse correlation with LDL cholesterol [r = -0.41, p<0.05]. When we compared the patients who had received corticosteroids, antimalarial, methotrexate and other medications with those who had not, we didn't find a significant statistical difference concerning the FMV. This study demonstrated that pre-menopausal patients with SLE free from cardiovascular risk factors and overt CVD have an altered endothelial reactivity which correlates positively with a CL positive subgroup of patients, SLEDAI disease activity score, serum CRP values, along with high LDL cholesterol concentration. This endothelial dysfunction indicates a higher susceptibility to the development of atherosclerotic disease