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      Evaluation of the intima-media complex in patients with systemic lupus erythematosus

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          Abstract

          The aim of the study

          The aim of the study was to determine whether there are any differences in the intima-media thickness (IMT) of carotid arteries between the group of patients with systemic lupus erythematosus (SLE) and the control group, and whether these differences are a consequence of SLE or independent factors of atherosclerosis development.

          Material and methods

          The patients were divided into three groups: the study group ( n = 25, mean age: 39.8 years) consisting of patients suffering from SLE; the subgroup ( n = 13, mean age: 39.2 years) consisting of patients suffering only from SLE without any accompanying diseases; and the control group ( n = 25, mean age: 37.1 years) consisting of healthy patients (not suffering from SLE or any other disease of the connective tissue). The IMT of the left and right common carotid arteries (LCCA, RCCA) was measured by means of ultrasound.

          Results

          The analysis performed with the Mann-Whitney U test showed that a statistically significant difference of IMT occurs between the control group and the study groups ( p = 0.006 for LCCA and p < 0.001 for RCCA), while there is no such relation ( p = 0.86 for RCCA and p = 0.095 for LCCA) between the control group and the subgroup.

          Conclusions

          The group of patients with SLE was found to have an increased IMT in comparison with the reference group. The unfavorable influence of independent factors of atherosclerosis development on the increase of the IMT value in patients with lupus was thus indicated. This observation suggests a faster atherosclerotic process in this group of patients.

          Translated abstract

          Celem badań

          Celem badań było określenie, czy występują różnice w grubości kompleksu intima-media (IMT) tętnic szyjnych pomiędzy grupą pacjentów z toczniem trzewnym układowym (SLE) i grupą kontrolną, a jeśli tak, to czy różnice te są następstwem tocznia czy niezależnych czynników rozwoju miażdżycy.

          Materiał i metody

          Pacjentów podzielono na trzy grupy. Grupa badana ( n = 25, średni wiek: 39,8 roku) obejmowała chorych na toczeń trzewny układowy. Do podgrupy badanej ( n = 13, średni wiek: 39,2 roku) włączono pacjentów chorujących jedynie na SLE, bez żadnych chorób towarzyszących. Do grupy kontrolnej włączono 25 zdrowych pacjentów (średni wiek: 37,1 roku), bez cech SLE lub innych schorzeń tkanki łącznej. Metodą ultrasonograficzną mierzono IMT obu tętnic szyjnych wspólnych.

          Wyniki

          W analizie przeprowadzonej z użyciem testu U Manna-Whitneya wykazano, że dla obu tętnic szyjnych zachodzi znamienna statystycznie różnica wartości IMT pomiędzy grupą kontrolną a badaną ( p = 0,006 dla LCCA i p < 0,001 dla RCCA), lecz brakuje takiej zależności pomiędzy grupą kontrolną a podgrupą badaną ( p = 0,86 dla RCCA i p = 0,095 dla LCCA).

          Wnioski

          W grupie chorych na SLE stwierdzono większą grubość kompleksu intima-media w porównaniu z populacją ludzi zdrowych. Wykazano ponadto istotny wpływ niezależnych czynników rozwoju miażdżycy na zwiększenie grubości kompleksu intima-media u pacjentów z toczniem trzewnym układowym. Obserwacja ta pozwala wnioskować o szybszym procesie miażdżycowym w tej grupie chorych.

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          Most cited references23

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          Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study.

          S Manzi, E Meilahn, J. E Rairie … (1997)
          The authors ascertained cardiovascular events (myocardial infarction and angina pectoris) in 498 women with systemic lupus erythematosus seen at the University of Pittsburgh Medical Center from 1980 to 1993 (3,522 person-years). Subjects were stratified by age, and cardiovascular event incidence rates were determined. The authors compared these rates with cardiovascular event rates were determined. The authors compared these rates with cardiovascular event rates occurring over the same time period in 2,208 women of similar age participating in the Framingham Offspring Study (17,519 person-years). Age-specific rate ratios were computed to determine whether the cardiovascular events in the lupus cohort were greater than expected. The risk factors associated with cardiovascular events in women with lupus were determined. There were 33 first events (11 myocardial infarction, 10 angina pectoris, and 12 both angina pectoris and myocardial infarction) after the diagnosis of lupus: two thirds were under the age of 55 years at the time of event. Women with lupus in the 35- to 44-year age group were over 50 times more likely to have a myocardial infarction than were women of similar age in the Framingham Offspring Study (rate ratio = 52.43, 95% confidence interval 21.6-98.5). Older age at lupus diagnosis, longer lupus disease duration, longer duration of corticosteroid use, hypercholesterolemia, and postmenopausal status were more common in the women with lupus who had a cardiovascular event than in those who did not have an event. Premature cardiovascular disease is much more common in young premenopausal women with lupus than in a population sample. With the increased life expectancy of lupus patients due to improved therapy, cardiovascular disease has emerged as a significant threat to the health of these women. The impact of this problem has been underrecognized, with little focus placed on aggressive management of hypercholesterolemia and other possible risk factors.
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            Common carotid intima-media thickness and risk of stroke and myocardial infarction: the Rotterdam Study.

            Michiel L. Bots, Arno Hoes, Peter J Koudstaal … (1997)
            Noninvasive assessment of intima-media thickness (IMT) is widely used in observational studies and trials as an intermediate or proxy end point for cardiovascular disease. However, data showing that IMT predicts cardiovascular disease are limited. We studied whether common carotid IMT is related to future stroke and myocardial infarction. We used a nested case-control approach among 7983 subjects aged > or =55 years participating in the Rotterdam Study. At baseline (March 1990 through July 1993), ultrasound images of the common carotid artery were stored on videotape. Determination of incident myocardial infarction and stroke was predominantly based on hospital discharge records. Analysis (logistic regression) was based on 98 myocardial infarctions and 95 strokes that were registered before December 31, 1994. IMT was measured from videotape for all case subjects and a sample of 1373 subjects who remained free from myocardial infarction and stroke during follow-up. The mean duration of follow-up was 2.7 years. Results were adjusted for age and sex. Stroke risk increased gradually with increasing IMT. The odds ratio for stroke per standard deviation increase (0.163 mm) was 1.41 (95% CI, 1.25 to 1.82). For myocardial infarction, an odds ratio of 1.43 (95% CI, 1.16 to 1.78) was found. When subjects with a previous myocardial infarction or stroke were excluded, odds ratios were 1.57 (95% CI, 1.27 to 1.94) for stroke and 1.51 (95% CI, 1.18 to 1.92) for myocardial infarction. Additional adjustment for several cardiovascular risk factors attenuated these associations: 1.34 (95% CI, 1.08 to 1.67) and 1.25 (95% CI, 0.98 to 1.58), respectively. The present study, based on a short follow-up period, provides evidence that an increased common carotid IMT is associated with future cerebrovascular and cardiovascular events.
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              The bimodal mortality pattern of systemic lupus erythematosus.

              M A Bookman, Vernita Gordon, Murray B. Urowitz … (1976)
              The changing pattern of mortality in systemic lupus erythematosus (SLE) led to an examination of the deaths in a long-term systematic analysis of 81 patients followed for five years at the University of Toronto Rheumatic Disease Unit. During the follow-up 11 patients died; six patients died within the first year after diagnosis (group I) and five patients died an average of 8.6 years (from 2.5 to 19.5 years) after diagnosis (group II). In those who died early, the SLE was active clinically and serologically, and nephritis was present in four. Their mean prednisone dose was 53.3 mg/day. In four patients a major septic episode contributed to their death. In those who died late in the course of the disease, only one patient had active lupus and none had active lupus nephritis. Their mean prednisone dose was 10.1 mg/day taken for a mean of 7.2 years. In none was sepsis a contributing factor to their death. All five of these patients had had a recent myocardial infarction at the time of death; in four, ti was the primary cause of death. Mortality in SLE follows a bimodal pattern. Patients who die early in the course of their disease, die with active lupus, receive large doses of steroids and have a remarkable incidence of infection. In those who die late in the course of the disease, death is associated with inactive lupus, long duration of steroid therapy and a striking incidence of myocardial infarction due to atherosclerotic heart disease.
              Article 0 comments Cited 176 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Kardiochir Torakochirurgia Pol
                Journal ID (iso-abbrev): Kardiochir Torakochirurgia Pol
                Journal ID (publisher-id): KITP
                Title: Kardiochirurgia i Torakochirurgia Polska = Polish Journal of Cardio-Thoracic Surgery
                Publisher: Termedia Publishing House
                ISSN (Print): 1731-5530
                ISSN (Electronic): 1897-4252
                Publication date (Electronic): 27 March 2014
                Publication date (Print): March 2014
                Volume: 11
                Issue: 1
                Pages: 63-68
                Affiliations
                [1 ]I Oddział Kliniczny Kardiologii, II Katedra, Śląski Uniwersytet Medyczny
                [2 ]Fundacja Rozwoju Kardiochirurgii, Zabrze
                Author notes
                Address for correspondence: Maciej Gawlikowski, Fundacja Rozwoju Kardiochirurgii, ul. Wolności 345 A, 41-800 Zabrze. phone: +48 88 060 75 27. e-mail: maciej.gawlikowski@ 123456poczta.onet.pl
                Article
                Publisher ID: 22558
                DOI: 10.5114/kitp.2014.41934
                PMC ID: 4283908
                SO-VID: ca3f2118-1710-421d-8a29-9af598366d6d
                Copyright © Copyright © 2014
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-Noncommercial 3.0 Unported License, permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 11 October 2013
                Date revision received : 31 October 2013
                Date accepted : 11 February 2014
                Categories
                Subject: Experimental Cardiovascular and Lung Research

                Keywords: carotid intima-media thickness,lupus erythematosus systemic
                Data availability:
                Keywords: carotid intima-media thickness, lupus erythematosus systemic

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