Background/Purpose: Studies have reported increased cardiovascular (CV) morbidity and mortality in patients with SLE. In recent years, several non-invasive surrogates of CV disease risk have become available to assess endothelial dysfunction (ED) and peripheral arterial stiffness (AS), which have been evaluated in SLE patients. The aim of this study was to systematically review and meta-analyze existing reports of CV disease (CVD) in SLE patients, as measured by ED and AS.

Methods: We performed a systematic review and meta-regression of studies evaluating the impact of SLE on the risk of ED and AS. Studies analyzing the relationship of SLE with ED (flow-mediated dilatation [FMD], nitroglycerin-mediated dilatation [NMD] and peripheral arterial tonometry [PAT]) and AS (augmentation index [AI], pulse wave velocity [PWV]) were systematically searched for in PubMed, EMBASE, Web of Science databases. Inclusion criteria included peer-reviewed publication, and report of original data in English. Mean differences (MD) and 95% confidence intervals (CIs) between SLE patients and controls were estimated using the random effect model.

The study was registered with PROSPERO, number CRD42019121068

Results: For the analysis of ED 21 studies were included. Compared with controls (n=644), SLE patients (n=943) showed a significantly lower mean FMD (MD= -4.30 %; 95% CI: -6.13%, -2.47%; p < 0.001). However, NMD did not significantly differ between SLE patients (n=404) and controls (n=265) (MD= – 2.68%; 95% CI -6.00, 0.62; p= 0.11). For the AS analysis 25 studies were included. A significantly-increased AS between SLE patients (n=1234) and controls (n=678) according to overall PWV (MD= 1.12 m/s; 95% CI 0.72-1.52; p < 0.001), central PWV (MD= 1.12 m/s; 95% CI 0.64, 1.59; p < 0.001), and peripheral PWV (MD= 1.52 m/s; 95% CI 0.82- 2.22; p < 0.001) was found, but not for the brachial-ankle PWV. AI (reported in 12 studies) was also increased in SLE patients (n=740) compared with healthy controls (n=411) (MD= 4.55%; 95% CI 1.48-7.63; p = 0.003).

Conclusion: SLE patients showed impaired FMD, an independent predictor of CV events. We also found a higher degree of AS in SLE patients compared with controls. The presence of ED and AS in SLE should be taken into account to plan adequate prevention strategies and therapeutic approaches.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/endothelial-dysfunction-and-arterial-stiffness-in-patients-with-systemic-lupus-erythematosus-a-systematic-review-and-meta-analysis/