Heart Care Info - Heart Disease Prevention & Treatment

... Year Period175. Clinical Outcomes in SLE Patients Since the Introduction Of 2003 ISN/RPS Classification of Lupus Nephritis176. Myocarditis Determines Survival in ...

S Shevchuk, I Segeda, I Kuvikova... - ..., 2011 - Br Soc Rheumatology Background: Patients with SLE are known to have early development of atherosclerotic process. However pathogenic mechanisms of accelerated atherogenesis is not completely detected in patients with SLE, though we think that chronic inflammatory process changes ...

Background: Patients with SLE are known to have early development of atherosclerotic process. However pathogenic mechanisms of accelerated atherogenesis is not completely detected in patients with SLE, though we think that chronic inflammatory process changes endothelium status and contributes to vascular impairment. Antiphospholipid syndrome (APS) is one of the most important causes of thrombosis in SLE. In addition, recent research indicates association of cardiovascular complications with hyperhomocysteinemia. The aim of this study was to investigate the association of thrombosis with plasma total homocysteine (pt Hcy), dyslipidemia, antiphospholipid antibodies (a PL) and other vascular risk factors in SLE patients.

Methods: 53 patients with SLE mean age 31,6 ± 6,8 years and 31 healthy persons age and sex-matched were examined. Mean duration of disease was 65 ± 4 months. Clinical and immunological data were obtained from our prospective computerized database. a PL-positivity was defined according to Sapporo criteria. In all patients with SLE activity of disease was evaluated according to disease activity index (SLEDAI). The median SLE disease activity index (SLEDAI) was 16,2 ± 7,5.

Results: There was no association between a PL and pt Hcy and dyslipidemia. pt Hcy was higher in patients with arterial (median 15.06 versus 11.12 micromol/L, P = 0.010) but not venous thrombosis. In the subgroup analysis, this association was only seen in a PL-negative patients. In logistic regression, a PL (OR 6.85, 95% CI 1.93-26.41) and pt Hcy (OR 1.12, 95% CI 1.07-1.31) were independently associated with arterial thrombosis. However, when hypertension, smoking and plasma total cholesterol were added to the model, only a PL (OR 7.68, 95% CI 2.02-31.84) and hypertension (OR 7.83, 95% CI 3.25-28.44), but not pt Hcy, remained independently related to arterial events. a PL was the only variable independently related to venous thrombosis (OR 7.76, 95% CI 1.70-34.46). pt Hcy concentrations and total cholesterol are higher in SLE patients with arterial thrombosis. No interaction between homocysteine, total cholesterol and a PL was found. We believe that increased levels pt Hcy and total cholesterol may be a marker of increased vascular risk in a PL-negative SLE patients.

Conclusions: In this study we did not find association between a PL with hyperhomocysteinemia and dyslipidemia, although hyperhomocysteinemia and dyslipidemia correlated with disease activity index (SLEDAI). The role of homocysteine and dyslipidemia as a marker of vascular risk may depend on the presence of traditional risk factors, such as man sex, smoking and hypertension, although a modest intrinsic effect cannot be entirely excluded.