Cor Vasa 2014, 56(2):e145-e152 | DOI: 10.1016/j.crvasa.2014.02.010

Cardiovascular events in patients with systemic lupus erythematosus

Andrea Smržová^*, Pavel Horák, Martina Skácelová, Martin Žurek, Ladislava Fryšáková, Helena Vaverková

III. interní klinika - nefrologická, revmatologická a endokrinologická, Lékařská fakulta Univerzity Palackého a Fakultní nemocnice Olomouc, Olomouc, Česká republika

Introduction: Systemic lupus erythematosus (SLE) is an autoimmune disorder characterized by multiorgan impairment. Cardiovascular involvement represents the leading cause of mortality in SLE patients. Its most common manifestations include pericarditis, valvular affections, conduction disorders, and arterial hypertension. Pulmonary hypertension and coronary arteritis are seen less often. Venous thrombosis directly related to SLE affects about 10% of SLE cases. Acceleration of atherosclerosis is very important and so are the ensuing cardiocerebral events, the most common of those being myocardial infarctions (MIs), cerebrovascular events, thromboembolic events (TEs), heart failure, and sudden death. We analyzed the frequency of cardiovascular events and their relationship to selected risk factors in a cohort of SLE patients followed in a single clinical center (Third Department of Internal Medicine - Nephrology, Rheumatology, and Endocrinology; Faculty Hospital of Palacký University, Olomouc).

Methods: The studied population comprised 63 SLE patients (women : men = 54 : 9, mean age 38.4 ± 12.7 years, mean disease duration 143 ± 173.5 months, BMI 24.74 ± 5.06, waist circumference 83.38 ± 16.58 cm), including 25 patients with lupus nephritis. Intima-media thickness (IMT) was assessed ultrasonographically in a standard manner, i.e. 10 mm proximally from the common carotid artery bifurcation on both sides. Of laboratory values, serum concentrations of total cholesterol (TC), triglycerides (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), anti-ds-DNA, antinucleosomal antibodies (ANUC), complement components C3 and C4, and ENA antibodies were measured. Clinical disease activity was assessed using indices of activity and cumulative damage SLEDAI and SLICC. Screening for traditional cardiovascular risk factors was based on appropriate questionnaires. Detailed analysis was employed to calculate cumulative doses of glucocorticoids and other immunosuppressants and to evaluate the use of anticoagulants, antiaggregants, statins, and ACE inhibitors.

Results: Twenty-one (33%) patients had a history of cardiovascular event during the course of their SLE - there were 3 myocardial infarctions (4.7% of the entire population, 14% of all cardiovascular events), 8 cerebrovascular events (12.7% of the entire population, 38% of all cardiovascular events), and 12 thromboembolic events (19% of the entire population, 57% of all cardiovascular events). In two patients, two different manifestations of cardiovascular involvement were combined - cerebrovascular event and MI in one, cerebrovascular event and EAP in the other. Cardiovascular events correlated with obesity, waist and hip circumference, smoking, total cholesterol, LDL, TC/HDL ratio, and apolipoproteins A-1 and B.
Borderline statistical significance was noted for disease activity (SLEDAI), hsCRP, positivity of RNP antibodies, anticardiolipin antibodies, and lupus anticoagulant (p = 0.06). The difference between groups concerning intima-media thickness was also just close to significant (p = 0.07). Subgroups of patients with MI, cerebrovascular events, TE, and arterial hypertension were also analyzed in more detail.

Conclusion: In this article, we point to the high rate of cardiovascular events in SLE patients, thus confirming the need to pay appropriate attention to cardiovascular problems in the field of rheumatology.

Keywords: Arterial hypertension; Cardiovascular event; Cerebrovascular event; Intima-media thickness; Myocardial infarction; Systemic lupus erythematosus; Thromboembolic event

Received: November 21, 2013; Revised: February 14, 2014; Accepted: February 15, 2014; Published: April 1, 2014  Show citation