Evaluation of risk factors that contribute to high prevalence of premature atherosclerosis in Chinese premenopausal systemic lupus erythematosus patients.
OBJECTIVE
To evaluate the prevalence of atherosclerosis in Chinese premenopausal women with systemic lupus erythematosus (SLE) and study possible associations between traditional and nontraditional risk factors with premature atherosclerosis.


METHODS
We evaluated 111 premenopausal women with SLE and 40 healthy controls without clinical cardiovascular disease. B-mode ultrasound was used to measure carotid plaque and intima-media wall thickness (IMT). The frequency of risk factors for atherosclerosis in patients and controls was compared, and the relationship between the patients' clinical characteristics and carotid plaque was examined. At the same time, we used B-mode ultrasound to measure flow-mediated dilation (FMD) and nitroglycerin-mediated dilation (NMD) in the brachial artery to assess for difference in endothelial function between SLE patients and controls.


RESULTS
Carotid plaque was more frequent in patients with lupus (16 of 111 patients) than in control subjects (0 of 40 subjects) (P = 0.007). The mean IMT was significantly higher in patients than in controls. Compared with controls, SLE patients were found to have a significantly higher prevalence of hypertension (P = 0.001), hypercholesterolemia (P = 0.022), and hypertriglyceridemia (P < 0.001). As compared with patients without plaque, patients with plaque were significantly older, had longer disease duration, higher body mass index, raised blood pressure, shorter prothrombin time, raised C-reactive protein, higher Systemic Lupus International Collaborating Clinics damage index score, higher cumulative prednisone dose, used less hydroxychloroquine, had higher mean IMT, lower FMD, and NMD. In logistic regression analysis, older age, higher body mass index, and higher Systemic Lupus International Collaborating Clinics damage index score were independently related to the presence of plaque. Using multiple regression analysis, we found SLE (P = 0.003) to be significantly associated with impaired FMD.


CONCLUSIONS
In our Chinese SLE group, patients presented a higher prevalence of carotid atherosclerosis plaque than healthy controls. SLE patients have significant endothelial dysfunction. We found that risk factors identified in other SLE populations were associated with atherosclerosis in our Chinese group.
Zhang
Chun-Yan
CY
Department of Rheumatic Diseases, Clinical Center of Rheumatology, Renji Hospital, Jiaotong University, Shanghai, People's Republic of China.
Lu
Liang-Jing
LJ
Li
Feng-Hua
FH
Li
Hong-Li
HL
Gu
Yue-Ying
YY
Chen
Shun-le
SL
Bao
Chun-De
CD
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D050197:Atherosclerosis / Q000150:complications* / Q000209:etiology; D015992:Body Mass Index; D002340:Carotid Artery Diseases / Q000150:complications*; D016022:Case-Control Studies; D002681:China; D005260:Female; D006801:Humans; D006973:Hypertension; D008180:Lupus Erythematosus, Systemic / Q000150:complications*; D008875:Middle Aged; D017697:Premenopause; D012307:Risk Factors; D012720:Severity of Illness Index; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology; D014664:Vasodilation; D055815:Young Adult