Background/Purpose: Patients with systemic lupus erythematosus (SLE) have an increased risk of developing atherosclerotic cardiovascular disease (CVD). In addition to traditional CVD risk factors or metabolic syndrome (MetS), SLE related factors may contribute to increased risk. The aim of this study was to assess subclinical atherosclerosis and the potential role of inflammatory mediators, vascular endotelial cell activation markers and adipocytokines in SLE in presence or absence of  MetS.

Methods: We studied 82 female SLE patients (35 with Mets, 47 without Mets) and 28 female healthy controls (HC) with no history of CVD. Mets were defined according to NCEP ATP III. Disease activity according to SLEDAI and  SLICC damage score were determined. Subclinical atherosclerosis was screened by measuring carotid intima media thickness(CIMT) by B-mode ultrasonography. Serum levels of  high sensitivity C-reactive protein(hs-CRP), tumor necrosis factor α(TNFα), interleukin 6(IL-6), soluble intercelluler adhesion molecule 1 (sICAM-1), sE-selectin, leptin and visfatin were measured.  Additional analysis were done for premenopausal patients. The comparison of groups was done by variance analysis and chi-square test when appropriate.

Results:

The mean age of  MetS+ SLE was 45± 11,  MetS- was  33±9,  HC was 28±6 mean disease duration of the patients were 84 ± 62 months. Most of the SLE patients (%79) were premenopousal. SLE patients were in clinical remission (mean SLEDAI= 1.06). Mean SLICC damage score was 0,29. CIMT values were  higher in  SLE patients than HC (mean CIMT left: 1.35±2,52mm vs 0.54±0,08mm right 1,28±2,40mm vs. 0,55±0,07mm, p=0,001). Only hsCRP, sICAM-1 and leptin  levels were higher in SLE patients than HC (p=0,001) and were correlated with carotid IMT values (left r= 0,3, p=0,02; r=0,47, r=0,35, p=0,001). The biomarkers studied were not related to serological or hematological activity. SLE mets+ group has higher CIMT values than SLE mets- (mean CIMT left: 1,74±3,17mm vs 1,06±1,91mm right: 2,11±3,54mm vs. 0,66±0,07mm p=0,001).  hsCRP and leptin levels were significantly higher in SLE Mets + than SLE Mets-  (p= 0,003, p=0,001). When SLE patients in premenopause were analysed, CIMT values were higher in SLE patients than HC (CIMT left: 1,1±1,9mm vs 0,54±0,08mm, p=0,02, right: 1±1,6mm vs 0,55±0,07mm, p=0,03 ). hsCRP, sICAM-1 and leptin  levels were higher in SLE patients (p=0,03, p=0,001, p=0,014). Only leptin levels were correlated with CIMT values (right r= 0,315, p=0,002).  In premenopausal SLE patients, mets+ group has higher IMT values than mets- (mean CIMT left: 1,21±2,07mm vs 1,07±1,92mm p=0,013, right: 1,72±2,83mm vs. 0,66±0,12mm p=0,001). Only leptin levels were higher in Mets+ than Mets- patients (p=0,005).

Conclusion:

In mainly premenopausal women with SLE without a history of CVD, CIMT values were found increased and related to Mets. This implies the importance of investigating Mets in identifying patients with subclinical atherosclerosis. Some biomarkers in SLE, especially leptin was increased in patients with Mets and correlated with carotid IMT values,  suggesting a relationship with subclinical atherosclerosis. The longitudinal follow-up of Mets and biomarkers may facilitate the prevention of overt CVD in SLE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-association-of-serum-biomarkers-and-metabolic-syndrome-with-subclinical-atherosclerosis-in-systemic-lupus-erythematosus-a-controlled-analysis-in-patients-with-no-clinical-disease-activity/