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Abstract
Background Many are the independent risk factors for premature atherosclerosis in general & peripheral vascular disease (PVD) in particular in SLE patients. Plasma homocysteine (HCY) is a known risk factor for atherosclerosis. Atherosclerosis can lead to many cardiovascular diseases as myocardial infarction, stroke and claudication
Objectives To compare the occurrence PVD of the lower extremity of SLE patients (pts) with age and sex matched controls and evaluate the role of HCY level in its occurrence
Methods Body mass index (BMI), blood pressure, lipid profile, titers of autoantibodies [ANA, anticardiolipin antibodies ACL (IgM, IgG)], C3, C4, plasma HCY level were assessed, SLEDAI and (SLICC/ACRDI)were calculated. PVD evaluation was done by measuring Ankle Brachial Index (ABI) with values <0.9 considered diagnostic of PVD; in 60 SLE pts and 30 age-matched controls. Patients with previous hypertension, diabetes, other collagenic diseases & smokers were excluded
Results Eighty-eight percent of the pts were women. The mean age (SD) was 30.40 (11.46) years & mean disease duration 3.61 (4.92)years. 50 pts were asymptomatic, 5 had mild & 5 had moderate claudications.SLE pts had significant higher total cholesterol (TC), LDL than controls 224.1±57.8 vs 181.1±41.1 mg/dl & 162.7±57.0 vs 119.5±13.4 (<0.001*) respectively, higher HCY 11.6±2.1 & 6.4±0.1 μmol/L (p<0.001*) & lower HDL 47.2±13.1 &52.6±3.7 mg/dl (p=0.004*). Low ABI was found in 30% of SLE pts but none of the controls (p=0.001*) & was correlated with higher HCY level (p=0.005*), TC & LDL (p<0.001* & p<0.001*), but not TG (p=0.748) or asymptomatic pts, presence of mild or moderate claudications (p=0.468,1.000, 0.154), still its value negatively correlated with lupus anticoagulant (LA) (p=0.002), ACL IgM (p<0.001*), the presence of lupus nephritis (LN) (p<0.001*) & SLICC/ACRDI (p=0.017*) but not with disease duration (dd) (p=0.535), Anti ds DNA (p=0.364), ACL IgG (p=0.8940), C4 (p=0.168) or SLEDAI (p=0.074).No correlation was found between HCY level and pts' age, dd, age at diagnosis, BMI, Anti ds DNA, ACL IgG, C4 & SLEDAI (p=0.521, 0.098, 0.946, 0.502, 0.346, 0.335, 0.325, 0.787). A positive correlation was found between HCY level and LA, ACL IgM, TC, LDL, the presence of LN & SLICC/ACRDI with a p value of 0.025*, <0.001*, <0.001*, 0.003*, 0.001*, 0.001* & negative one with HDL p=0.023*
Conclusions 83.3% of SLE pts were asymptomatic or had atypical symptoms of PVD still 30% of the patients had low ABI. ABI can be a more reliable, non-invasive test to assess PVD than the conventional methods of pulse palpation or history of claudication in SLE pts.Both traditional & nontraditional risk factors of atherosclerosis are important but HCY can play a role, among other factors, as independent risk factor of PVD in SLE
References
Rayford R et al. PVD in SLE Patients. J Clin Rheum. 2013; 7:367–70.
References
Disclosure of Interest None declared