The relationship between disease-related risk factors and premature atherosclerosis in systemic lupus erythematosus / 中华风湿病学杂志

ABSTRACT

Objective To evaluate the prevalence of atherosclerosis in Chinese premenopausal women with systemic lupus erythematosus (SLE) and study possible associations between non-traditional risk factors with premature atherosclerosis. Methods One hundred and eleven premenopausal women with SLE and 40 healthy controls without clinical cardiovascular disease were evaluated. B-mode ultrasonography was used to measure carotid plaque and intima-media wall thickness( IMT). The relationship between the patients' clinical characteristics and carotid plaque was examined. At the same time, B-mode ultrasound was used to measure flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) in the brachial artery. Using this method, the difference in endothelial function between SLE patients and controls was assessed. T-test,χ2 test and logistic regression were used for statistical analysis. Results Carotid plaque was more frequently observed in patients with SLE (16 of 111 patients) than in control subjects (0 of 40 subjects) (P=0.007). The mean IMT (m-IMT) (0.62 mm vs 0.45 mm, P<0.01) and maximum IMT(M-IMT) (0.7 mm vs 0.6 mm, P<0.01) was significantly higher in patients than in controls. As compared with patients without plaque, patients with plaque were significantly older, had longer disease duration, higher body mass index (BMI), higher blood pressure, shorter prothrombin time, elevated C-reactive protein level, higher SLICC score, higher cumulative prednisone dose, less hydroxychloroquine accumulated dosage, higher m-IMT and M-IMT, lower FMD and NMD. In logistic regression analysis, older age (P=0.012, OR=1.137), higher BMI (P=0.051, OR=1.205) and higher SLICC score (P=0.000, OR=2.888) were independently related to the presence of plaque. Conclusion SLE patients have higher prevalence of carotid atherosclerosis plaque than healthy controls and the age at onset is younger than controls. In addition to traditional risk factors for cardiovascular disease, SLE itself and disease related factors play important roles in premature atherosclerosis in SLE. SLE patients have significant endothelial dysfunction. Thus, endothelial dysfunction can be regarded as one manifestation of premature atherosclerosis in SLE.