Increased arterial stiffness in systemic lupus erythematosus (SLE) patients at low risk for cardiovascular disease: a cross-sectional controlled study

Abstract

Cardiovascular disease (CVD) is a major cause of death in systemic lupus erythematosus (SLE) patients. Although the risk for cardiovascular events in patients with SLE is significant, the absolute number of events per year in any given cohort remains small. Thus, CVD risks stratification in patients with SLE focuses on surrogate markers for atherosclerosis at an early stage, such as reduced elasticity of arteries. Our study was designed to determine whether arterial stiffness is increased in SLE patients at low risk for CVD and analyze the role for traditional and non-traditional CVD risk factors on arterial stiffness in SLE. Carotid-femoral pulse wave velocity (PWV) was prospectively assessed as a measure of arterial stiffness in 41 SLE patients and 35 controls (CTL). Adjustment on age or Framingham score was performed using a logistic regression model. Factors associated with PWV were identified separately in SLE patients and in controls using Pearson's correlation coefficient for univariate analysis and multiple linear regression for multivariate analysis. SLE patients and controls displayed a low 10-year risk for CVD according to Framingham score (1.8±3.6% in SLE vs 1.6±2.8% in CTL, p = 0.46). Pulse wave velocity was, however, higher in SLE patients (7.1±1.6 m/s) as compared to controls (6.3±0.8 m/s; p = 0.01, after Framingham score adjustment) and correlated with internal carotid wall thickness (p = 0.0017). In multivariable analysis, only systolic blood pressure (p = 0.0005) and cumulative dose of glucocorticoids (p = 0.01) were associated with PWV in SLE patients. Interestingly, the link between systolic blood pressure (SBP) and arterial stiffness was also confirmed in SLE patients with normal systolic blood pressure. In conclusion, arterial stiffness is increased in SLE patients despite a low risk for CVD according to Framingham score and is associated with systolic blood pressure and glucocorticoid therapy.

Figure 1. Pulse Wave Velocity (PWV) is high in SLE patients and correlates with systolic blood pressure.

(A) Pulse wave velocity (PWV) are higher in SLE patients (SLE, n = 41, right) as compared to controls (CTL, n = 35, left) and (B) correlated with internal carotid wall thickness (ICWT). (C) SLE patients and controls were stratified according to systolic blood pressure quartiles (SBP <119; 120–126, >127–135, >137 mmHg). Two-ways ANOVA showed a significant independent interaction of SBP and group (SLE, CTL) on PWV. (D) PWV correlated with systolic blood pressure (SBP) in SLE subjects with (white circles) and without (black circles) high systolic blood pressure. Plain and dashed lines represented linear regression in SLE subjects with and without high systolic blood pressure (SBP), respectively. p was calculated after age adjustment. m/s refers to meter per second; mm, to millimeter; r, to linear correlation coefficient