Background Patients with Systemic lupus erythematosus (SLE) have an increased risk for cardiovascular disease (CVD) and develop early atherosclerosis. A possible explanation could be the metabolic syndrome likely associated with a combination of factors, including traditional risk factors, disease and its therapy related factors, proinflammatory mediators (C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-18 (IL-18), soluble receptor type 1 of tumor necrosis factor-α (sTNF-R1).
Objectives To evaluate metabolic syndrome (MetS) prevalence and it’s association with subclinical atherosclerosis, inflammatory mediators of atherosclerosis (CRP, IL-6, IL-18, sTNF-R1) and SLE-related factors in patients with SLE.
Methods We observed 154 women (mean age 35 (27-43) years), fulfilling ≥4 ACR criteria for SLE, and 69 controls (women without any rheumatic and infectious diseases, matched for age 36 (30-48) years). We considered the CVD, traditional cardiovascular risk factors and SLE-related factors (age at onset, duration of SLE, clinical features, SLE Disease Activity Index (SLEDAI-2K) and the Systemic Lupus International Collaborating Clinics damage index (SLICC), treatment with steroids). The MetS was assessed using NCEP ATP III definitions.Carotid intima-media wall thickness (IMT) was measured by high resolution B-mode ultrasound. A plaque was defined as a local intimal-medial thickening with a thickness ≥1,2 mm, normal IMT<0,9 mm. The levels of CRP, IL-6, IL-18 and sTNF-R1 were determined in serum samples by the highly sensitive particle-enhanced immunonephelometric assay.
Results The mean disease duration of SLE patients was 99 (43-204) months, SLEDAI-2K score - 8 (4,0-16), SLICC/ACR damage index score - 2 (0-3), duration of steroid treatment - 72 (26-141) months, cumulative steroid doses - 22 (9-63) g. The SLE patients had significantly higher prevalence of MetS (19% vs 7% in controls, d=0,02), hypertension (51% vs 20%, p<0,00001), higher concentration of TG level (1,4 (0,9-2,0) vs 0,5(0,3-0,8) mmol/l, p<0,05). The frequency of CVD was 14% in patients and 2% in controls p<0,01, the carotid plaque had observed in 15% patients and 4% controls p<0,05. The CRP level was higher in women with SLE than in control: 2,2 (0,9-4,5) vs 0,6 (0,2-2,0) mg/l respectively (p<0,05). We divided SLE patients on two groups: with MetS and without MetS. SLE women with MetS was older, they had a higher SLEDAI-2K and SLICC score, higher prevalence of subclinical atherosclerosis, concentration of CRP, IL-6, IL-18, sTNF-R1 (* p<0,05 in all cases) (Table 1).
Conclusions The prevalence of metabolic syndrome was higher in women with SLE than control. MetS was associated with subclinical atherosclerosis, SLE activity, damage index and inflammatory mediators of atherosclerosis (CRP, IL-6, IL-18, sTNF-R1) in SLE women.
Disclosure of Interest None Declared