Longitudinal study on premature atherosclerosis in patients with systemic lupus erythematosus.
OBJECTIVE
To determine risk factors of accelerated atherosclerosis and progression of intima-media thickness (IMT) in patients with systemic lupus erythematosus (SLE).


METHODS
74 SLE patients, age ranging from 13 to 69 years, and 74 age- and sex-matched controls were included. IMT of the common carotid artery was determined by B-mode ultrasound imaging. Traditional risk factors for atherosclerosis and disease-related factors were recorded. Cardiovascular risk was estimated using systematic coronary risk evaluation (SCORE). Markers of inflammation (C-reactive protein, CRP) and endothelial activation (thrombomodulin, vascular cell adhesion molecule-1, and von Willebrand factor) were determined. Measurements were repeated in 52 patients after a follow-up of 32+/-7 months.


RESULTS
IMT was increased in SLE patients compared to controls. Prevalence of smoking and hypertension, use of lipid-lowering drugs and SCORE were higher in patients, as well as levels of CRP and markers of endothelial activation. The age-related increase in IMT was significantly higher in patients than in controls. In multivariate analysis, age and disease duration was independently related to IMT. Increase in IMT during follow-up was related to age only.


CONCLUSIONS
The age-related increase in IMT is higher in SLE, indicating that atherosclerosis is accelerated in SLE patients. This is mainly due to disease-related risk factors, as disease duration was independently associated with IMT.
de Leeuw
Karina
K
Department of Rheumatology & Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. k.de.leeuw@int.umcg.nl
Smit
Andries J
AJ
de Groot
Eric
E
van Roon
Arie M
AM
Kallenberg
Cees G
CG
Bijl
Marc
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D050197:Atherosclerosis / Q000209:etiology*; D002097:C-Reactive Protein / Q000378:metabolism; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D018180:Thrombomodulin / Q000097:blood; D017539:Tunica Intima / Q000000981:diagnostic imaging / Q000473:pathology; D017540:Tunica Media / Q000000981:diagnostic imaging / Q000473:pathology; D014463:Ultrasonography; D019010:Vascular Cell Adhesion Molecule-1 / Q000097:blood
D018180:Thrombomodulin; D019010:Vascular Cell Adhesion Molecule-1; D002097:C-Reactive Protein