Background lupus nephritis (LN) has been associated with accelerated atherosclerosis leading to increased cardio- and cerebrovascular disease risk. Stress oxidative bio markers besides the Traditional risk factors, and systemic inflammatory cytokines, plays an important role in development of these vascular pathologies. Because of major role of cardiovascular disease (CVD) in morbidity and mortality of patients with LN, The aim of this study was to evaluate subclinical atherosclerosis and effect of mentioned factors for CVD in LN patients.
Objectives forty SLE patients(38 women and 2 men)aged (30.4±8.65) with a definite diagnosis of LN and 40 age- and sex-matched healthy controls were included in this prospective study.
Methods all patients andhealthy controls underwent physical examination, carotid arteries B-mode ultrasound for carotid Intima-media thickness (CIMT) as a surrogate measure of atherosclerosis. Traditional risks factors total cholesterol (TC), TG, LDLc, glycaemia, hyper tension, and non-traditional atherosclerotic risks factors such as 24 hours proteinuria, serum albumin and creatinine, CRP and oxidative stress bio markers like tioles (homocysteine) and malondialdehyde (MDA), were also tested in both groups. The serologic markers of lupus andstage and activity index of lupus nephritis was recorded in LN patients.
Results Mean MDA (4.08±1.39) and homocysteine(23.50±15.86)levels as oxidative biomarkers was significantly higher in patients comparing controls(1.76±0.73) and(2.71±1.57) respectively(p<0.001). Both mean CIMT of patients at right (0.74 ±.47) and Left (.74 ±.17) sides were significantly higher than controls (0.58±0.11) & (0.61±.12) (p<0.001).stage 4 and 3of lupus nephritis had the strongest relation with both level of oxidative stress biomarkers (p<0.007) and CIMT(p<0.001). There were statically significant difference between creatinine, serum Albumin, CRP, Hypertension and triglycerides of LN patients and healthy controls but at multivariate analysis of mentioned risk factors and oxidative biomarkers, homocysteine level (p<0.01) and MDA (p<0.05) were independent predictors of CIMT.
Conclusions CIMT was significantly increased in SLE populations. Although inflammatory markers and lupus related factors may contribute to the development of atherosclerosis, but nontraditional risk factors oxidative products such as hyper hemocysteinemia and MDA were independent meaningful predictors in our study.
Mary J. Roman, M.D., Beth-Ann Shanker, A.B., Adrienne Davis, A.B., Michael D. Lockshin, M.D., Lisa Sammaritano, M.D., Ronit Simantov, M.D., Mary K. Crow, M.D., et al. (2003) Prevalence and Correlates of Accelerated Atherosclerosis in Systemic Lupus Erythematosus. N Engl J Med;349:2399-406
Kaplan MJ. Premature vascular damage in systemic lupus erythematosus. Autoimmunity. 2009 Nov;42(7):580-6
Moroni G, Novembrino C, Quaglini S, De Giuseppe R, Gallelli B, Uva V, Montanari V, Messa P, Bamonti F. Oxidative stress and homocysteine metabolism in patients with lupus nephritis. Lupus. 2010 Jan;19(1):65-72
Disclosure of Interest None Declared
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