Session Information
Session Title: Systemic Lupus Erythematosus - Clinical Aspects I - Renal, Malignancy, Cardiovascular Disease
Session Type: Abstract Submissions (ACR)
Background/Purpose: Cardiovascular diseases (CVD) are one of major causes of morbidity and mortality in SLE patients. Traditional cardiovascular risk factors and disease intrinsic factors contribute to this pathogenesis. Endothelial progenitors cells (EPCs) are involved in the re-endothelialization of damaged vessels and contribute to endothelial dysfunction. SLE patients have endothelial dysfunction and have fewer EPCs than healthy controls. Angiotensin converting enzyme (ACE) inhibitors such as ramipril in patients with coronary heart disease improve endothelial function and reduced CV morbidity and mortality. The Objective of the study was to evaluate the effect of ramipril on endothelial function as well on the number and function of EPCs in SLE patients
Methods:
Prospective, randomized, controlled trial. Female patients with SLE (ACR criteria) over 18 years of age, with stable medications were invited to participate. Risk factors for CVD were exclusion criteria. SLE patients who signed consent form were randomized into two groups: intervention group (IG) and control group (CG). The IG used ramipril 10mg/day for 12 weeks. All patients were assessed at baseline and after 12 weeks, with a physical exam and also collected blood sample. Disease activity was assessed by SLEDAI score and EPCs were evaluated by culture using Endocult (Stemcell Technologies, USA), according appropriate protocol and by flow cytometry using anti-KDR-APC (R&D Systems, USA), anti-CD34-FITC (Southern Biotech Assoc Inc, USA), anti-CD133-PE (Miltenyi Biotec, USA) and 7AAD (Southern Biotech Assoc. Inc, USA). The assessment of endothelial function was done through an ultrasonography of the brachial artery and flow mediated dilation (FMD), according the established protocol. Student t test was used for normally distributed variables, Fisher exact test for categorical variables and ANOVA for repeated measures. Intent to treat analysis was done. P < 0.05 was considered significant.
Results:
37 SLE patients were evaluated , 18 in IG and 19 in CG.
At baseline, there was no difference between IG and CG regarding the average of age, disease duration, arterial pressure, LDL cholesterol, BMI, FMD, use of immunosuppressive drug and SLEDAI score. We found a significant increase on FMD in IG (6.17±4.18% vs 11.14±5.4%, p<0.001), without difference in CG ( 5.37±3.91% vs 5, 02±3.62%, p=0.630), comparing first (baseline) and final (12 weeks) assessment. We also found a increase in the number of colony forming units (CFU) of EPCs in IG (21.3±10.4 vs 31.6±8.5, p<0.001), without difference in CG (24.8±13.5 vs 25.8±11.6, p=0.714). There was no difference concerning EPCs number evaluated by cytometry in IG (0.013 %±0.025 vs 0.02%±0.03 p=0.734) either in CG (0.0175±0.024 vs 0.012%±0.016%, p=0.734)
Conclusion: Ramipril improved endothelial function in patients with SLE and also increased the number of EPCs evaluated in cell culture, suggesting that the improvement of endothelial function can be due to the increase in EPCs function. ACE inhibitors should be used as a preferential drug to treat hypertension in SLE patients and may be could reduce CVD in these patients
Disclosure:
E. I. Sato,
None;
L. S. G. Machado,
None;
A. C. Machado,
None.
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