Cardiovascular disease (CVD) due to premature atherosclerosis is a leading cause of morbidity and mortality in systemic lupus erythematosus (SLE) patients. The early detection of endothelial dysfunction may be useful in clinical practice to prevent SLE patients from further developing atherosclerosis and CVD. Also exercising tight control of CV risk factors is essential to reduce complications, as well as maintain strict control of SLE activity itself, which plays a relevant role in the pathogenesis of premature atherosclerosis.
Mara Taraborelli, MD, and colleagues from Azienda Socio Sanitaria Territoriale degli Spedali Civili di Brescia, Brescia, Italy, sought to assess the prevalence of endothelial dysfunction and related risk factors in SLE patients with early disease using peripheral arterial tonometry (PAT). PAT is a noninvasive assessment of endothelial dysfunction that may be promising for SLE patients.
In the study, 20 SLE patients with a median disease duration of 14 months (range 1–58 months) were matched with healthy controls. Participants had no history of CVD or risk factors. Both patients and controls underwent a transthoracic Doppler echocardiogram and an evaluation of endothelial function by PAT. Researchers also assessed arterial stiffness using the peripheral augmentation index, automatically standardized per 75 beats per minute (AIx at 75). The study results were published in September 2018 Arthritis Care & Research.
The Results
“A high rate of endothelial dysfunction and vascular stiffness was detected in early lupus patients without CV risk factors and disease,” write the authors in their discussion. “A systemic inflammatory process, despite lasting for a relatively short time and being discretely controlled, arguably may lead to impaired function of endothelial tissue and vascular stiffness, even in the absence of traditional CV risk factors.”
In the study, controls did not show any sign of altered endothelial function. And “when looking for correlations between [SLE] patients’ characteristics and the presence of endothelial dysfunction, we were not able to detect any significant association,” add the authors.
The authors conclude by calling for larger studies examining SLE patient characteristics, as well as possible inflammatory biomarkers known to be implicated in altering endothelial function, associated with the abnormalities assessed by PAT. They also suggest research into how treatments affect PAT.
Taraborelli M, Sciatti E, Bonadei I, et al. Endothelial dysfunction in early systemic lupus erythematosus patients and controls without previous cardiovascular events. Arthritis Care Res (Hoboken). 2018 Sep;70(9):1277–1283.