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DelOlmo-Romero S, Medina-Martínez I, Gil-Gutierrez R, Pocovi-Gerardino G, Correa-Rodríguez M, Ortego-Centeno N, Rueda-Medina B. Metabolic syndrome in systemic lupus erythematosus patients under Mediterranean diet. Med Clin (Barc) 2024; 162:259-264. [PMID: 38040571 DOI: 10.1016/j.medcli.2023.10.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 10/10/2023] [Accepted: 10/11/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND AND AIMS Metabolic syndrome (MetS) is a chronic proinflammatory and prothrombotic condition that exacerbates insulin resistance, oxidative damage, and cardiovascular risk, being more prevalent in patients with systemic lupus erythematosus (SLE), a chronic multisystemic autoimmune disorder. This study aim was to determine the prevalence of MetS and associations with SLE clinical characteristics, cardiovascular risk and dietary pattern in a population of Spanish SLE patients. DESIGN AND METHODS Cross-sectional study of 293 patients was conducted (90.4% females; mean age 46.8 (12.94)). The diagnosis of MetS was established based on the criteria of the National Cholesterol Education Program Adult Treatment Panel III. SLE Disease Activity Index (SLEDAI-2K) and SDI Damage Index were used to assess disease activity and disease-related damage, respectively. Med Diet adherence was assessed through a 14 items questionnaire on food consumption frequency and habits. RESULTS MetS was present in 15% SLE patients. Triglycerides, high-density lipoprotein cholesterol, systolic blood pressure and waist circumference were significantly increased (p<0.001) in the group of MetS patients. Patients with MetS showed significantly increased SDI damage index (1.70 (1.69) vs 0.88 (1.12), p<0.001) and complement C3 level (118.70 (32.67) vs 107.55 (26.82), p=0.011). No significant differences were observed according to Med Diet adherence level. CONCLUSION We observed a lower prevalence of MetS in SLE than that reported in previous studies, which may be a result of the good level of adherence to the MedDiet in our study sample. Additionally, MetS was associated with higher SDI and complement C3 levels but no with medication use.
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Affiliation(s)
- Sara DelOlmo-Romero
- Institute of Biomedical Research (IBS), Granada, Spain; Nursing Department, Faculty of Health Sciences, University of Granada, Granada, Spain.
| | - Irene Medina-Martínez
- Institute of Biomedical Research (IBS), Granada, Spain; Nursing Department, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Rocio Gil-Gutierrez
- Institute of Biomedical Research (IBS), Granada, Spain; Nursing Department, Faculty of Health Sciences, University of Granada, Granada, Spain
| | | | - María Correa-Rodríguez
- Institute of Biomedical Research (IBS), Granada, Spain; Nursing Department, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Norberto Ortego-Centeno
- Institute of Biomedical Research (IBS), Granada, Spain; Faculty of Medicine, University of Granada, Granada, Spain
| | - Blanca Rueda-Medina
- Institute of Biomedical Research (IBS), Granada, Spain; Nursing Department, Faculty of Health Sciences, University of Granada, Granada, Spain
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Zachou K, Azariadis K, Lytvyak E, Snijders RJ, Takahashi A, Gatselis NK, Robles M, Andrade RJ, Schramm C, Lohse AW, Tanaka A, Drenth JP, Montano-Loza AJ, Dalekos GN. Treatment responses and outcomes in patients with autoimmune hepatitis and concomitant features of non-alcoholic fatty liver disease. JHEP Rep 2023; 5:100778. [PMID: 37456672 PMCID: PMC10339258 DOI: 10.1016/j.jhepr.2023.100778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 07/18/2023] Open
Abstract
Background & Aims Non-alcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH) affect 17-46% of Western countries, making coexistence with other liver diseases inevitable. We investigated the prevalence and clinical significance of NAFLD/NASH or the components of metabolic syndrome (MetS) in a large multicentric cohort of patients with autoimmune hepatitis (AIH). Methods Data from six academic centres (Greece, Canada, Japan, Germany, The Netherlands, and Spain) were evaluated. The presence of NAFLD/NASH in liver biopsy, MetS components, and clinical and laboratory parameters were recorded. Results A total of 640 patients (474 females, age 49 [4-87] years; follow-up 78 [1-521] months) were included. NAFLD was present in 146 (22.8%) patients (AIH/non-alcoholic fatty liver [NAFL] 115 [18%], AIH/NASH 31 [4.8%]). AIH/NAFL patients were older (p = 0.017), more frequently overweight or obese (p = 0.002), had hypertension (p = 0.001), and had diabetes (p = 0.016), whereas they less frequently had acute presentation (p = 0.002) and soluble liver antigen/liver pancreas positivity (p <0.05), lower transaminases (p <0.001), ALP (p = 0.028) and IgG (p = 0.004) and higher albumin (p <0.001) than patients with AIH only. Patients with AIH/NASH more frequently had cirrhosis at diagnosis (p = 0.036) and higher IgG (p = 0.009). Response to treatment did not differ between groups. Patients with cirrhosis with AIH/NAFL had higher frequency of decompensation compared with patients with AIH only (p <0.05). Patients with type 2 diabetes mellitus and dyslipidaemia had increased hazard of disease progression (p <0.05 for each). Conclusions The prevalence of NAFLD in AIH is similar to the general population. Concurrence of NASH in patients with AIH signifies a more severe disease, whereas that of NAFL may indicate a worse prognosis in patients with cirrhosis. T2DM and dyslipidaemia in AIH patients are associated with dismal parameters of outcome. Our findings suggest that NAFLD presence or even components of MetS in patients with AIH may affect prognosis, so closer follow-up of such patients is warranted. Impact and implications Non-alcoholic fatty liver disease (NAFLD) and steatohepatitis (NASH) affect many people, making coexistence with other liver diseases inevitable. We investigated the prevalence and clinical significance of NAFLD/NASH or the components of metabolic syndrome (MetS) in patients with autoimmune hepatitis (AIH). NAFLD and NASH presence in patients with AIH is as frequent as in the general population. The concurrence of NASH in patients with AIH seems to signify a more severe disease, whereas that of non-alcoholic fatty liver may indicate a worse prognosis in a specific subgroup of patients who already have cirrhosis at diagnosis. Diabetes or dyslipidaemia in patients with AIH were associated with worse prognosis. Therefore, it seems that closer follow-up of patients with concurrent AIH and NAFLD or AIH and components of MetS is needed.
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Affiliation(s)
- Kalliopi Zachou
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Kalliopi Azariadis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Ellina Lytvyak
- Division of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Romée J.A.L.M. Snijders
- Department of Gastroenterology and Hepatology, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Radboud UMC, Nijmegen, The Netherlands
| | - Atsushi Takahashi
- Department of Gastroenterology, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Nikolaos K. Gatselis
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
| | - Mercedes Robles
- Unidad De Gestión Clínica De Aparato Digestivo, Servicio De Farmacología Clínica, Hospital Universitario Virgen De La Visctoria, Universidad De Malaga, Malaga, Spain
| | - Raul J. Andrade
- Unidad De Gestión Clínica De Aparato Digestivo, Servicio De Farmacología Clínica, Hospital Universitario Virgen De La Visctoria, Universidad De Malaga, Malaga, Spain
| | - Christoph Schramm
- Department of Medicine and Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Ansgar W. Lohse
- Department of Medicine and Martin Zeitz Centre for Rare Diseases, University Medical Centre Hamburg-Eppendorf, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Hamburg, Germany
| | - Atsushi Tanaka
- Department of Medicine, Tokyo University, School of Medicine, Itabashi-Ku, Tokyo, Japan
| | - Joost P.H. Drenth
- Department of Gastroenterology and Hepatology, European Reference Network on Hepatological Diseases (ERN RARE-LIVER), Radboud UMC, Nijmegen, The Netherlands
| | - Aldo J. Montano-Loza
- Division of Gastroenterology and Liver Unit, University of Alberta, Edmonton, Alberta, Canada
| | - George N. Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, National Expertise Center of Greece in Autoimmune Liver Diseases, General University Hospital of Larissa, Larissa, Greece
- European Reference Network on Hepatological Diseases (ERN RARE-LIVER), General University Hospital of Larissa, Larissa, Greece
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Garcia-de los Ríos C, Medina-Casado M, Díaz-Chamorro A, Sierras-Jiménez M, Lardelli-Claret P, Cáliz-Cáliz R, Sabio JM. Sclerostin as a biomarker of cardiovascular risk in women with systemic lupus erythematosus. Sci Rep 2022; 12:21621. [PMID: 36517533 PMCID: PMC9749620 DOI: 10.1038/s41598-022-25651-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 12/02/2022] [Indexed: 12/15/2022] Open
Abstract
Cardiovascular disease is one of the main causes of death in patients with systemic lupus erythematosus (SLE). On the other hand, sclerostin is a reliable and early biomarker of vascular calcification. This study aimed to estimate the association between sclerostin and two markers of cardiovascular risk, carotid atherosclerotic plaque (CP) and carotid-femoral pulse wave velocity (PWV), in women with SLE. The presence of CP (determined by carotid artery ultrasound) and PWV were measured in 68 women with SLE and preserved renal function. None of the participants had a history of cardiovascular disease. Serum levels of sclerostin were determined using the ELISA method. Other factors associated with increased cardiovascular risk were also measured. The association between sclerostin, CP and PWV was assessed using Receiver Operating Characteristic (ROC) curves and multivariate regression models. The area under the ROC curve was 0.785 (95% confidence interval [CI] 0.662-0.871) for CP and 0.834 (95% CI 0.729-0.916) for dichotomized PWV. After adjusting for other cardiovascular risk factors, it was found that a 10-units increase in sclerostin values was associated with a 44% increase in the odds of CP (95% CI 1-105), but no adjusted association was observed between sclerostin and PWV. Predictive models included age (for both outcomes), hypertension, Framingham risk score and C-reactive protein (for PWV), but not sclerostin. Sclerostin is associated with the presence of CP in women with SLE. Further research should confirm its possible role as a biomarker of cardiovascular risk in these patients.
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Affiliation(s)
- Carlos Garcia-de los Ríos
- grid.411380.f0000 0000 8771 3783Department of Internal Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | | | - Antonio Díaz-Chamorro
- grid.411380.f0000 0000 8771 3783Department of Internal Medicine, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - María Sierras-Jiménez
- grid.411380.f0000 0000 8771 3783Emergency Department, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - Pablo Lardelli-Claret
- grid.4489.10000000121678994Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain ,Centros de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain ,grid.507088.2Instituto de Investigación Biosanitaria Ibs.GRANADA, Granada, Spain
| | - Rafael Cáliz-Cáliz
- grid.411380.f0000 0000 8771 3783Department of Rheumatology, Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - José Mario Sabio
- grid.411380.f0000 0000 8771 3783Systemic Autoimmune Diseases Unit, Department of Internal Medicine, 9th Floor, Hospital Universitario Virgen de las Nieves, Avda. Fuerzas Armadas, Nº 2, 18014 Granada, Spain
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Guzmán-Martínez G, Marañón C. Immune mechanisms associated with cardiovascular disease in systemic lupus erythematosus: A path to potential biomarkers. Front Immunol 2022; 13:974826. [PMID: 36420265 PMCID: PMC9677819 DOI: 10.3389/fimmu.2022.974826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/13/2022] [Indexed: 10/29/2023] Open
Abstract
Systemic lupus erythematosus (SLE) patients display an increased risk of cardiovascular disease (CVD). With the improved clinical management of other classical severe manifestation of the disease, CVD is becoming one of the most relevant complications of SLE, and it is an important factor causing morbidity and mortality. Several immune constituents have been shown to be involved in the pathogenesis of atherosclerosis and endothelial damage in SLE patients, including specific circulating cell populations, autoantibodies, and inflammatory mediators. In this review, we summarize the presentation of CVD in SLE and the role of the autoimmune responses present in SLE patients in the induction of atherogenesis, endothelial impairment and cardiac disease. Additionally, we discuss the utility of these immune mediators as early CVD biomarkers and targets for clinical intervention in SLE patients.
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Affiliation(s)
- Gabriela Guzmán-Martínez
- Atrys Health, Madrid, Spain
- Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
- Department of Cardiology, La Paz University Hospital, IdiPaz, Madrid, Spain
| | - Concepción Marañón
- Department of Genomic Medicine, Pfizer-University of Granada-Andalusian Regional Government Centre for Genomics and Oncological Research (GENYO), Granada, Spain
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Kim SK, Choe JY. Metabolic syndrome at baseline was not predictive to new-onset cardiovascular diseases in patients with systemic lupus erythematosus: A prospective observational registry. EUR J INFLAMM 2022. [DOI: 10.1177/1721727x221113400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: It has been established that metabolic syndrome is prevalent in patients with systemic lupus erythematosus (SLE). The objective of this study was to investigate the effect of metabolic syndrome at baseline on new-onset cardiovascular disease (CVD) in patients with SLE. Methods: The demographic and lupus-related clinical variables of 229 patients with SLE were collected from the Korean Lupus Network (KORNET) registry. Metabolic syndrome was defined by the modified National Cholesterol Education Program’s Adult Treatment Panel III (NCEP ATP III) criteria. Binary logistic regression analysis was applied to identify clinical variables including metabolic syndrome related to pre-existing CVD at the time of enrollment or new-onset CVD during 3 years of follow-up. Results: Patients with pre-existing CVD at baseline had higher rates of metabolic syndrome than those without CVD in SLE ( p = .022), whereas there was no difference in the frequency of metabolic syndrome between patients with and without new-onset CVD. Logistic regression analysis revealed that metabolic syndrome and the number of its components were associated with pre-existing CVD, together with body mass index and hypertriglyceridemia. Metabolic syndrome at baseline and its components were not related with increased risk of new-onset CVD. On the contrary, anti-dsDNA antibody titer, anti-ds DNA positivity, and lower diastolic blood pressure increased the risk of new-onset CVD. Conclusion: This study demonstrated that metabolic syndrome at baseline was not predictive to new-onset CVD at 3 years of follow-up, although it was associated with pre-existing CVD in SLE.
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Affiliation(s)
- Seong-Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Jung-Yoon Choe
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
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Chew C, Reynolds JA, Lertratanakul A, Wu P, Urowitz M, Gladman DD, Fortin PR, Bae SC, Gordon C, Clarke AE, Bernatsky S, Hanly JG, Isenberg D, Rahman A, Sanchez-Guerrero J, Romero-Diaz J, Merrill J, Wallace D, Ginzler E, Khamashta M, Nived O, Jönsen A, Steinsson K, Manzi S, Kalunian K, Dooley MA, Petri M, Aranow C, van Vollenhoven R, Stoll T, Alarcón GS, Lim SS, Ruiz-Irastorza G, Peschken CA, Askanase AD, Kamen DL, İnanç M, Ramsey-Goldman R, Bruce IN. Lower vitamin D is associated with metabolic syndrome and insulin resistance in systemic lupus: data from an international inception cohort. Rheumatology (Oxford) 2021; 60:4737-4747. [PMID: 33555325 DOI: 10.1093/rheumatology/keab090] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/07/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Vitamin D (25(OH)D) deficiency and metabolic syndrome (MetS) may both contribute to increased cardiovascular risk in systemic lupus erythematosus (SLE). We aimed to examine the association of demographic factors, SLE phenotype, therapy and vitamin D levels with MetS and insulin resistance. METHODS The Systemic Lupus International Collaborating Clinics (SLICC) enrolled patients recently diagnosed with SLE (<15 months) from 33 centres across 11 countries from 2000. Clinical, laboratory and therapeutic data were collected. Vitamin D level was defined according to tertiles based on distribution across this cohort, which were set at T1 (10-36 nmol/l), T2 (37-60 nmol/l) and T3 (61-174 nmol/l). MetS was defined according to the 2009 consensus statement from the International Diabetes Federation. Insulin resistance was determined using the HOMA-IR model. Linear and logistic regressions were used to assess the association of variables with vitamin D levels. RESULTS Of the 1847 patients, 1163 (63%) had vitamin D measured and 398 (34.2%) subjects were in the lowest 25(OH)D tertile. MetS was present in 286 of 860 (33%) patients whose status could be determined. Patients with lower 25(OH)D were more likely to have MetS and higher HOMA-IR. The MetS components, hypertension, hypertriglyceridemia and decreased HDL were all significantly associated with lower 25(OH)D. Increased average glucocorticoid exposure was associated with higher insulin resistance. CONCLUSIONS MetS and insulin resistance are associated with lower vitamin D in patients with SLE. Further studies could determine whether vitamin D repletion confers better control of these cardiovascular risk factors and improve long-term outcomes in SLE.
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Affiliation(s)
- Christine Chew
- Lydia Becker Institute of Immunology and Inflammation, Manchester Collaborative Centre for Inflammation Research, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - John A Reynolds
- Sandwell and West Birmingham NHS Trust, Birmingham, UK.,Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | | | - Peggy Wu
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Murray Urowitz
- Toronto Western Hospital Centre for Prognosis Studies in the Rheumatic Diseases Toronto, ON, CAN
| | - Dafna D Gladman
- Toronto Western Hospital Centre for Prognosis Studies in the Rheumatic Diseases Toronto, ON, CAN
| | - Paul R Fortin
- Department of Rheumatology, Université Laval Faculté de médecine, Quebec, QC, CAN
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seongdong-gu, Seoul, KR
| | - Caroline Gordon
- Rheumatology Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, UK
| | - Ann E Clarke
- Divisions of Clinical Immunology/Allergy and Clinical Epidemiology, University of Calgary Cumming School of Medicine, Calgary, AB, CAN
| | - Sasha Bernatsky
- Faculty of Medicine, Division of Rheumatology, McGill University, Montreal, QC, CAN
| | - John G Hanly
- Queen Elizabeth II Health Sciences Centre, Division of Rheumatology, Department of Medicine and Department of Pathology Halifax, NS, CAN
| | - David Isenberg
- Faculty of Medical Sciences, Division of Medicine, University College London, London, London, UK
| | - Anisur Rahman
- Faculty of Medical Sciences, Division of Medicine, University College London, London, London, UK
| | - Jorge Sanchez-Guerrero
- Toronto Western Hospital Centre for Prognosis Studies in the Rheumatic Diseases Toronto, ON, CAN
| | - Juanita Romero-Diaz
- Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Immunology and Rheumatology Tlalpan, DF, MX
| | - Joan Merrill
- Department of Clinical Pharmacology, Oklahoma Medical Research Foundation Arthritis and Clinical Immunology Research Program, Oklahoma City, OK, USA
| | | | - Ellen Ginzler
- Department of Medicine, SUNY Downstate Medical Center College of Medicine, Brooklyn, NY, USA
| | - Munther Khamashta
- Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, London, UK
| | - Ola Nived
- Faculty of Medicine, Department of Clinical Sciences Lund, Section of Rheumatology, Lunds University, Lund, SE
| | - Andreas Jönsen
- Faculty of Medicine, Department of Clinical Sciences Lund, Section of Rheumatology, Lunds University, Lund, SE
| | - Kristjan Steinsson
- Department of Rheumatology, National University Hospital of Iceland, Reykjavik, Capital, IS
| | - Susan Manzi
- Allegheny Health Network, Lupus Center of Excellence, Pittsburgh, PA, USA
| | - Ken Kalunian
- University of California San Diego School of Medicine, La Jolla, CA, USA
| | - Mary Anne Dooley
- University of North Carolina at Chapel Hill, Division of Rheumatology and Immunology, Department of Medicine, Chapel Hill, NC, USA
| | - Michelle Petri
- Department of Rheumatology, Johns Hopkins University School of Medicine Center for Musculoskeletal Research, Baltimore, MD, USA
| | - Cynthia Aranow
- Northwell Health Feinstein Institutes for Medical Research, Manhasset, NY, USA
| | | | - Thomas Stoll
- Department of Rheumatology, Kantonsspital Schaffhausen, Schaffhausen, Schaffhausen, CH
| | - Graciela S Alarcón
- Department of Medicine, Division of Clinical Immunology and Rheumatology, The University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - S Sam Lim
- Division of Rheumatology, Emory University School of Medicine, Atlanta, GA, USA
| | - Guillermo Ruiz-Irastorza
- Hospital Universitario Cruces, Autoimmune Diseases Units, Biocruces Bizkaia Health Research Institute, Barakaldo, País Vasco, ES
| | | | - Anca D Askanase
- Columbia University Irving Medical Center, New York, NY, USA
| | - Diane L Kamen
- Columbia University Irving Medical Center, New York, NY, USA
| | - Murat İnanç
- Faculty of Medicine, Department of Internal Medicine, Division of Rheumatology, Istanbul University Istanbul, Istanbul, Istanbul, TR
| | | | - Ian N Bruce
- Manchester University NHS Foundation Trust, NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester, Greater Manchester, UK.,Versus Arthritis Centre for Epidemiology, Division of Musculoskeletal and Dermatological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester, UK
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Abstract
Introduction: The metabolic syndrome (MetS) is now recognized as a chronic proinflammatory and prothrombotic state that aggravates insulin resistance, oxidative injury, and cardiovascular risk. MetS is more prevalent in patients with systemic lupus erythematosus (SLE), a prototype of systemic autoimmune disease associated with premature atherosclerosis that cannot be accounted by traditional vascular risk factors alone. Dysregulation of the cytokines and adipokines is a common feature in both SLE and MetS, suggesting a complex relationship among autoimmunity, obesity, inflammation, and atherosclerosis. Areas covered: This review summarizes the prevalence of MetS and its effect on cardiovascular outcome and organ damage in patients with SLE. The pathophysiology of MetS and its relevance to SLE is also briefly discussed. Expert opinion: Imbalance of adipokine production in MetS contributes to inflammation and atherosclerosis. MetS predisposes SLE patients to new cardiovascular events and vascular mortality, as well as the development of chronic kidney disease and diabetes mellitus. However, conflicting results have been reported in the literature regarding the levels of the proinflammatory leptin and anti-inflammatory adiponectin, and their relationship with disease activity in SLE patients. While lifestyle modifications and targeting dyslipidemia, hypertension and diabetes mellitus is essential, there is little information on the efficacy and safety of metformin and hydroxychloroquine in alleviating insulin resistance in SLE or MetS. Further research on adipokines in SLE and the role of anti-obesity medications and probiotics in MetS is necessary.
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Affiliation(s)
- Chi Chiu Mok
- a Department of Medicine , Tuen Mun Hospital , Hong Kong , SAR China
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8
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Demir S, Erten G, Artım-Esen B, Şahinkaya Y, Pehlivan Ö, Alpay-Kanıtez N, Deniz G, Inanç M. Increased serum leptin levels are associated with metabolic syndrome and carotid intima media thickness in premenopausal systemic lupus erythematosus patients without clinical atherosclerotic vascular events. Lupus 2018; 27:1509-1516. [PMID: 29954279 DOI: 10.1177/0961203318782424] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim To assess subclinical atherosclerosis and the role of inflammatory mediators, vascular endothelial cell activation markers and adipocytokines in systemic lupus erythematosus (SLE) in the presence or absence of metabolic syndrome (MetS). Methods We studied 66 premenopausal female SLE patients (20 with MetS) and 28 female healthy controls (HCs) without history of cardiovascular disease (CVD). Subclinical atherosclerosis was screened by measuring carotid intima media thickness (CIMT). Serum levels of high sensitivity C-reactive protein (hs-CRP), tumour necrosis factor α (TNFα), interleukin 6 (IL-6), soluble intercellular adhesion molecule 1 (sICAM-1), soluble E-selectin, leptin and visfatin were measured. Results The mean age of MetS+SLE, MetS- and HC were 38.3 ± 6.7, 32.7 ± 9.3 and 29.9 ± 5.6 years, respectively. The mean disease duration, SLICC (Systemic Lupus International Collaborating Clinics damage index) and Systemic Lupus Erythematosus Disease Activity Index scores were 74.8 ± 54.9 months, 0.16 ± 0.48 and 1.18 ± 1.5, respectively, and were similar between MetS+and MetS- SLE patients. CIMT values were higher in both MetS+ and MetS- SLE patients than HCs ( p < 0.001). sICAM-1 and erythrocyte sedimentation rate levels were higher in both MetS+ and MetS- SLE patients than HCs ( p < 0.001; p = 0.002, p = 0.001). The SLE MetS+ group had higher CIMT values than SLE MetS- (right: p = 0.003; left: p = 0.025). Leptin levels and homeostatic model assessment (HOMA) scores were significantly higher in SLE MetS+ than SLE MetS- ( p = 0.018; p = 0.04). Leptin and CRP levels and body mass index, SLICC and HOMA scores were correlated with CIMT values (right: p = 0.03, p < 0.001, p < 0.001, p = 0.026 and p < 0.001, and left: p = 0.028, p = 0.03, p = 0.003, p = 0.002 and p = 0.025). Conclusions In premenopausal women with SLE without a history of CVD, CIMT values were increased and related to MetS. Leptin was increased in patients with MetS and correlated with CIMT values.
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Affiliation(s)
- S Demir
- 1 Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - G Erten
- 2 Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - B Artım-Esen
- 1 Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Y Şahinkaya
- 1 Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - Ö Pehlivan
- 1 Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - N Alpay-Kanıtez
- 1 Department of Internal Medicine, Istanbul University, Istanbul, Turkey
| | - G Deniz
- 2 Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - M Inanç
- 1 Department of Internal Medicine, Istanbul University, Istanbul, Turkey
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10
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Fatemi A, Ghanbarian A, Sayedbonakdar Z, Kazemi M, Smiley A. Metabolic syndrome in Iranian patients with systemic lupus erythematosus and its determinants. Clin Rheumatol 2018; 37:1521-1528. [PMID: 29305669 DOI: 10.1007/s10067-017-3970-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 11/27/2017] [Accepted: 12/22/2017] [Indexed: 11/28/2022]
Abstract
The aim of this study was to determine the prevalence of metabolic syndrome (MetS) in Iranian patients with systemic lupus erythematosus (SLE) and its determinants. In a cross-sectional study, 98 patients with SLE and 95 controls were enrolled. Prevalence of MetS was determined based on American Heart Association and National Heart, Lung, and Blood Institute (AHA/NHLBI) and 2009 harmonizing criteria. In addition, demographic features and lupus characteristics such as disease duration, pharmacological treatment, laboratory data, SLE disease activity index (SLEDAI), and Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage index (SDI) were recorded. The predictors of MetS were obtained by backward stepwise regression analysis. Using AHA/NHLBI, MetS was observed in 35 (35.7%) patients and 28 (29.8%) controls (P = 0.4). Using harmonizing criteria, MetS was observed in 37 (37.7%) patients and 33 (35.1%) controls (P = 0.7). There was no difference in frequency distribution of MetS components between the patients and the controls. In multivariate regression analysis, low C3, blood urea nitrogen (BUN), and body mass index were independent determinants of MetS in lupus patients. BUN, low C3, and body mass index were the major determinants of MetS in lupus patients.
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Affiliation(s)
- Alimohammad Fatemi
- Department of Rheumatology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Azadeh Ghanbarian
- Department of Internal Medicine, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Sayedbonakdar
- Department of Rheumatology, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mehdi Kazemi
- Department of Internal Medicine, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Abbas Smiley
- Department of Epidemiology and Biostatistics, School of Public Health, Indiana University, Bloomington, IN, USA
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11
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Hallajzadeh J, Khoramdad M, Izadi N, Karamzad N, Almasi-Hashiani A, Ayubi E, Qorbani M, Pakzad R, Sullman MJM, Safiri S. The association between metabolic syndrome and its components with systemic lupus erythematosus: a comprehensive systematic review and meta-analysis of observational studies. Lupus 2018; 27:899-912. [PMID: 29301471 DOI: 10.1177/0961203317751047] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Based upon inflammatory-related factors in chronic systemic lupus erythematosus (SLE), as well as the long-term prescription of corticosteroids, metabolic syndrome (MetS) prevalence is expected to be higher in SLE patients than among those without SLE. The aim of this study was to systematically analyze: (1) the worldwide prevalence of MetS in patients with SLE using different criteria, (2) the risk of MetS in patients with SLE compared with those without SLE, and (3) the risk of MetS component in patients with SLE compared with healthy controls. METHODS We searched international databases, such as: Web of Science, Medline, PubMed, Scopus, Embase, CABI, CINAHL, DOAJ and Google Scholar. The articles which reported the prevalence of MetS in SLE patients, between 2006 and 2017, were included in the study if they had a: clear study design, study time and location, sound sampling approach and appropriate statistical analyses. Studies without sufficient data to determine the prevalence of MetS were excluded. Also, studies in patients suffering from other clinical diseases were not included. RESULTS The meta-analyses of the prevalence (40 studies (n = 6085)) and risk (20 studies (n = 2348)) of MetS in SLE patients were conducted separately. The pooled prevalence of MetS among SLE patients was found to be 26% (95% confidence interval (CI): 22-30%), but varied from 18% (95% CI: 11-25%) to 34% (95% CI: 25-42%), depending upon the diagnostic criteria used. The overall pooled odds ratio (OR) of MetS in SLE patients, compared with healthy controls, was (OR = 2.50; 95% CI: 1.86-3.35), but this ranged from (OR = 1.23; 95% CI: 0.61-2.49) to (OR = 10.71; 95% CI: 1.33-86.48), depending upon the criteria used. Also, the risk of high fasting blood sugar (FBS; OR = 1.59; 95% CI: 1.05-2.40), low high-density lipoprotein cholesterol (HDL-C; OR = 1.43; 95% CI: 1.02-2.01), high blood pressure (BP; OR = 2.76; 95% CI: 2.19-3.47), high triglycerides (TG; OR = 2.85; 95% CI: 2.05-3.95) and high waist circumference (WC; OR = 1.37; 95% CI: 0.97-1.94) were all found to be higher in SLE patients compared with healthy controls. CONCLUSIONS The risk of MetS was significantly higher in SLE patients, compared with healthy controls, even after adjusting for publication bias. Among MetS components, high TG and high BP were most strongly associated with SLE. Considering that high TG and high BP are preventable, there is an international need to implement effective interventions to reduce MetS components in SLE patients in order to prevent serious outcomes such as cardiovascular diseases and mortality.
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Affiliation(s)
- J Hallajzadeh
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, 440826 Maragheh University of Medical Sciences , Maragheh, Iran
| | - M Khoramdad
- Department of Epidemiology and Biostatistics, Faculty of Health, 48464 Kermanshah University of Medical Sciences , Kermanshah, Iran
| | - N Izadi
- Department of Epidemiology, School of Public Health, 48486 Shahid Beheshti University of Medical Sciences , Tehran, Iran
| | - N Karamzad
- Nutrition Research Center, Department of Biochemistry and Diet Therapy, School of Nutrition and Food Sciences, 48432 Tabriz University of Medical Sciences , Tabriz, Iran
| | - A Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, 48499 Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran
| | - E Ayubi
- Department of Community Medicine, School of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran
| | - M Qorbani
- Non-Communicable Diseases Research Center, 391934 Alborz University of Medical Sciences , Karaj, Iran
| | - R Pakzad
- Department of Epidemiology, Faculty of Health, 48443 Ilam University of Medical Sciences , Ilam, Iran
| | - M J M Sullman
- Department of Psychology, Middle East Technical University, Northern Cyprus Campus, Güzelyurt/Morphou, Northern Cyprus
| | - S Safiri
- Managerial Epidemiology Research Center, Department of Public Health, School of Nursing and Midwifery, 440826 Maragheh University of Medical Sciences , Maragheh, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, 48439 Tehran University of Medical Sciences , Tehran, Iran
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12
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Sun C, Qin W, Zhang YH, Wu Y, Li Q, Liu M, He CD. Prevalence and risk of metabolic syndrome in patients with systemic lupus erythematosus: A meta-analysis. Int J Rheum Dis 2017; 20:917-928. [PMID: 28851080 DOI: 10.1111/1756-185x.13153] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Chong Sun
- Department of Dermatology; First Hospital of China Medical University; Shenyang China
| | - Wen Qin
- Department of Obstetrics and Gynecology; Shan Dong University Hospital; Jinan China
| | - Yu-Hui Zhang
- Department of Dermatology; First Hospital of China Medical University; Shenyang China
| | - Yan Wu
- Department of Dermatology; First Hospital of China Medical University; Shenyang China
| | - Qian Li
- Department of Dermatology; First Hospital of China Medical University; Shenyang China
| | - Mei Liu
- Department of Dermatology; First Hospital of China Medical University; Shenyang China
| | - Chun-Di He
- Department of Dermatology; First Hospital of China Medical University; Shenyang China
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13
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Effects of risk factors for and components of metabolic syndrome on the quality of life of patients with systemic lupus erythematosus: a structural equation modeling approach. Qual Life Res 2017; 27:105-113. [DOI: 10.1007/s11136-017-1689-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2017] [Indexed: 01/09/2023]
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14
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Giannelou M, Mavragani CP. Cardiovascular disease in systemic lupus erythematosus: A comprehensive update. J Autoimmun 2017; 82:1-12. [PMID: 28606749 DOI: 10.1016/j.jaut.2017.05.008] [Citation(s) in RCA: 118] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 05/31/2017] [Indexed: 12/21/2022]
Abstract
Heightened rates of both cardiovascular (CV) events and subclinical atherosclerosis, documented by imaging and vascular function techniques are well established in systemic lupus erythematosus (SLE). While traditional CV factors such as smoking, dyslipidemia, diabetes mellitus (DM), hypertension, central obesity and hyperhomocysteinemia have been reported to be prevalent in lupus patients, they do not fully explain the high rates of ischemic events so far reported, implying that other factors inherent to disease itself could account for the enhanced risk, including disease duration, activity and chronicity, psychosocial factors, medications, genetic variants and altered immunological mechanisms. Though the exact pathogenesis of atherosclerosis in the setting of lupus remains ill defined, an imbalance between endothelial damage and atheroprotection seems to be a central event. Insults leading to endothelial damage in the setting of lupus include oxidized low density lipoprotein (oxLDL), autoantibodies against endothelial cells and phospholipids, type I interferons (IFN) and neutrophil extracellular traps (NETs) directly or through activation of type I IFN pathway. Increased oxidative stress, reduced levels of the normally antioxidant high density lipoprotein (HDL), increased levels of proinflammatory HDL (piHDL) and reduced paraoxonase activity have been related to increased oxLDL levels. On the other hand, impaired atheroprotective mechanisms in lupus include decreased capacity of endothelial repair-partly mediated by type I IFN- and dampened production of atheroprotective autoantibodies. In the present review, traditional and disease related risk factors for CV disease (CVD) in the setting of chronic autoimmune disorders with special focus on SLE will be discussed.
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Affiliation(s)
- Mayra Giannelou
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Rheumatology, General Hospital of Athens "G. Gennimatas", Greece
| | - Clio P Mavragani
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Greece; Department of Physiology, School of Medicine, National and Kapodistrian University of Athens, Greece; Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
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15
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Maloney KC, Ferguson TS, Stewart HD, Myers AA, De Ceulaer K. Clinical and immunological characteristics of 150 systemic lupus erythematosus patients in Jamaica: a comparative analysis. Lupus 2017; 26:1448-1456. [PMID: 28480787 DOI: 10.1177/0961203317707828] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background Epidemiological studies in systemic lupus erythematosus have been reported in the literature in many countries and ethnic groups. Although systemic lupus erythematosus in Jamaica has been described in the past, there has not been a detailed evaluation of systemic lupus erythematosus patients in urban Jamaica, a largely Afro-Caribbean population. The goal of this study was to describe the clinical features, particularly disease activity, damage index and immunological features, of 150 systemic lupus erythematosus subjects. Methods 150 adult patients (≥18 years) followed in rheumatology clinic at a tertiary rheumatology hospital centre (one of two of the major public referral centres in Jamaica) and the private rheumatology offices in urban Jamaica who fulfilled Systemic Lupus International Collaborating Clinics (SLICC) criteria were included. Data were collected by detailed clinical interview and examination and laboratory investigations. Hence demographics, SLICC criteria, immunological profile, systemic lupus erythematosus disease activity index 2000 (SLEDAI-2K) and SLICC/American College of Rheumatology (ACR) damage index (SDI) were documented. Results Of the 150 patients, 145 (96.7%) were female and five (3.3%) were male. The mean age at systemic lupus erythematosus onset was 33.2 ± 10.9. Mean disease duration was 11.3 ± 8.6 years. The most prevalent clinical SLICC criteria were musculoskeletal, with 141 (94%) of subjects experiencing arthralgia/arthritis, followed by mucocutaneous manifestations of alopecia 103 (68.7%) and malar rash 46 (30.7%), discoid rash 45 (30%) and photosensitivity 40 (26.7%). Lupus nephritis (biopsy proven) occurred in 42 (28%) subjects and 25 (16.7%) met SLICC diagnostic criteria with only positive antinuclear antibodies/dsDNA antibodies and lupus nephritis on renal biopsy. The most common laboratory SLICC criteria were positive antinuclear antibodies 136 (90.7%) followed by anti-dsDNA antibodies 95 (63.3%) and low complement (C3) levels 38 (25.3%). Twenty-seven (18%) met SLICC diagnostic criteria with only positive antinuclear antibodies/anti-dsDNA antibodies and lupus nephritis on renal biopsy. Mean SLEDAI score was 6.9 ± 5.1 with a range of 0–32. Organ damage occurred in 129 (86%) patients; mean SDI was 2.4 ± 1.8, with a range of 0–9. Conclusion These results are similar to the clinical manifestations reported in other Afro-Caribbean populations; however, distinct differences exist with respect to organ involvement and damage, particularly with respect to renal involvement, which appears to be reduced in our participants.
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Affiliation(s)
- K C Maloney
- Department of Medicine, University of the West Indies, Mona, Jamaica
| | - T S Ferguson
- Epidemiology Research Unit, Caribbean Institute for Health Research, University of the West Indies, Mona, Jamaica
| | - H D Stewart
- Department of Medicine, University of the West Indies, Mona, Jamaica
| | - A A Myers
- Department of Medicine, University of the West Indies, Mona, Jamaica
| | - K De Ceulaer
- Department of Medicine, University of the West Indies, Mona, Jamaica
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16
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Romero M, Toral M, Robles-Vera I, Sánchez M, Jiménez R, O'Valle F, Rodriguez-Nogales A, Pérez-Vizcaino F, Gálvez J, Duarte J. Activation of Peroxisome Proliferator Activator Receptor β/δ Improves Endothelial Dysfunction and Protects Kidney in Murine Lupus. Hypertension 2017; 69:641-650. [PMID: 28242713 DOI: 10.1161/hypertensionaha.116.08655] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/13/2016] [Accepted: 01/30/2017] [Indexed: 01/08/2023]
Abstract
Women with systemic lupus erythematosus exhibit a high prevalence of hypertension, endothelial dysfunction, and renal injury. We tested whether GW0742, a peroxisome proliferator activator receptor β/δ (PPARβ/δ) agonist, ameliorates disease activity and cardiovascular complications in a female mouse model of lupus. Thirty-week-old NZBWF1 (lupus) and NZW/LacJ (control) mice were treated with GW0742 or with the PPARβ/δ antagonist GSK0660 plus GW0742 for 5 weeks. Blood pressure, plasma double-stranded DNA autoantibodies and cytokines, nephritis, hepatic opsonins, spleen lymphocyte populations, endothelial function, and vascular oxidative stress were compared in treated and untreated mice. GW0742 treatment reduced lupus disease activity, blood pressure, cardiac and renal hypertrophy, splenomegaly, albuminuria, and renal injury in lupus mice, but not in control. GW0742 increased hepatic opsonins mRNA levels in lupus mice and reduced the elevated T, B, Treg, and Th1 cells in spleens from lupus mice. GW0742 lowered the higher plasma concentration of proinflammatory cytokines observed in lupus mice. Aortae from lupus mice showed reduced endothelium-dependent vasodilator responses to acetylcholine and increased nicotinamide adenine dinucleotide phosphate oxidase-driven vascular reactive oxygen species production, which were normalized by GW0742 treatment. All these effects of GW0742 were inhibited by PPARβ/δ blockade with GSK0660. Pharmacological activation of PPARβ/δ reduced hypertension, endothelial dysfunction, and organ damage in severe lupus mice, which was associated with reduced plasma antidouble-stranded DNA autoantibodies and anti-inflammatory and antioxidant effects in target tissues. Our findings identify PPARβ/δ as a promising target for an alternative approach in the treatment of systemic lupus erythematosus and its associated vascular damage.
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Affiliation(s)
- Miguel Romero
- From the Department of Pharmacology, School of Pharmacy (M.R., M.T., I.R.-V., M.S., R.J., A.R.-N., F.P.-V., J.G., J.D.), Department of Pathology, School of Medicine (F.O.), and CIBER-EHD, Center for Biomedical Research (CIBM) (J.G.), University of Granada, Spain; Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, Spain (M.R., R.J., F.O., J.G., J.D.); CIBER Enfermedades Cardiovasculares, Granada, Spain (R.J., J.D.); Department of Pharmacology, School of Medicine, University Complutense of Madrid, Spain (F.P.-V.); CIBER Enfermedades Respiratorias, Madrid, Spain (F.P.-V.); and Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain (F.P.-V.)
| | - Marta Toral
- From the Department of Pharmacology, School of Pharmacy (M.R., M.T., I.R.-V., M.S., R.J., A.R.-N., F.P.-V., J.G., J.D.), Department of Pathology, School of Medicine (F.O.), and CIBER-EHD, Center for Biomedical Research (CIBM) (J.G.), University of Granada, Spain; Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, Spain (M.R., R.J., F.O., J.G., J.D.); CIBER Enfermedades Cardiovasculares, Granada, Spain (R.J., J.D.); Department of Pharmacology, School of Medicine, University Complutense of Madrid, Spain (F.P.-V.); CIBER Enfermedades Respiratorias, Madrid, Spain (F.P.-V.); and Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain (F.P.-V.)
| | - Iñaki Robles-Vera
- From the Department of Pharmacology, School of Pharmacy (M.R., M.T., I.R.-V., M.S., R.J., A.R.-N., F.P.-V., J.G., J.D.), Department of Pathology, School of Medicine (F.O.), and CIBER-EHD, Center for Biomedical Research (CIBM) (J.G.), University of Granada, Spain; Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, Spain (M.R., R.J., F.O., J.G., J.D.); CIBER Enfermedades Cardiovasculares, Granada, Spain (R.J., J.D.); Department of Pharmacology, School of Medicine, University Complutense of Madrid, Spain (F.P.-V.); CIBER Enfermedades Respiratorias, Madrid, Spain (F.P.-V.); and Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain (F.P.-V.)
| | - Manuel Sánchez
- From the Department of Pharmacology, School of Pharmacy (M.R., M.T., I.R.-V., M.S., R.J., A.R.-N., F.P.-V., J.G., J.D.), Department of Pathology, School of Medicine (F.O.), and CIBER-EHD, Center for Biomedical Research (CIBM) (J.G.), University of Granada, Spain; Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, Spain (M.R., R.J., F.O., J.G., J.D.); CIBER Enfermedades Cardiovasculares, Granada, Spain (R.J., J.D.); Department of Pharmacology, School of Medicine, University Complutense of Madrid, Spain (F.P.-V.); CIBER Enfermedades Respiratorias, Madrid, Spain (F.P.-V.); and Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain (F.P.-V.)
| | - Rosario Jiménez
- From the Department of Pharmacology, School of Pharmacy (M.R., M.T., I.R.-V., M.S., R.J., A.R.-N., F.P.-V., J.G., J.D.), Department of Pathology, School of Medicine (F.O.), and CIBER-EHD, Center for Biomedical Research (CIBM) (J.G.), University of Granada, Spain; Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, Spain (M.R., R.J., F.O., J.G., J.D.); CIBER Enfermedades Cardiovasculares, Granada, Spain (R.J., J.D.); Department of Pharmacology, School of Medicine, University Complutense of Madrid, Spain (F.P.-V.); CIBER Enfermedades Respiratorias, Madrid, Spain (F.P.-V.); and Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain (F.P.-V.)
| | - Francisco O'Valle
- From the Department of Pharmacology, School of Pharmacy (M.R., M.T., I.R.-V., M.S., R.J., A.R.-N., F.P.-V., J.G., J.D.), Department of Pathology, School of Medicine (F.O.), and CIBER-EHD, Center for Biomedical Research (CIBM) (J.G.), University of Granada, Spain; Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, Spain (M.R., R.J., F.O., J.G., J.D.); CIBER Enfermedades Cardiovasculares, Granada, Spain (R.J., J.D.); Department of Pharmacology, School of Medicine, University Complutense of Madrid, Spain (F.P.-V.); CIBER Enfermedades Respiratorias, Madrid, Spain (F.P.-V.); and Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain (F.P.-V.)
| | - Alba Rodriguez-Nogales
- From the Department of Pharmacology, School of Pharmacy (M.R., M.T., I.R.-V., M.S., R.J., A.R.-N., F.P.-V., J.G., J.D.), Department of Pathology, School of Medicine (F.O.), and CIBER-EHD, Center for Biomedical Research (CIBM) (J.G.), University of Granada, Spain; Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, Spain (M.R., R.J., F.O., J.G., J.D.); CIBER Enfermedades Cardiovasculares, Granada, Spain (R.J., J.D.); Department of Pharmacology, School of Medicine, University Complutense of Madrid, Spain (F.P.-V.); CIBER Enfermedades Respiratorias, Madrid, Spain (F.P.-V.); and Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain (F.P.-V.)
| | - Francisco Pérez-Vizcaino
- From the Department of Pharmacology, School of Pharmacy (M.R., M.T., I.R.-V., M.S., R.J., A.R.-N., F.P.-V., J.G., J.D.), Department of Pathology, School of Medicine (F.O.), and CIBER-EHD, Center for Biomedical Research (CIBM) (J.G.), University of Granada, Spain; Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, Spain (M.R., R.J., F.O., J.G., J.D.); CIBER Enfermedades Cardiovasculares, Granada, Spain (R.J., J.D.); Department of Pharmacology, School of Medicine, University Complutense of Madrid, Spain (F.P.-V.); CIBER Enfermedades Respiratorias, Madrid, Spain (F.P.-V.); and Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain (F.P.-V.)
| | - Julio Gálvez
- From the Department of Pharmacology, School of Pharmacy (M.R., M.T., I.R.-V., M.S., R.J., A.R.-N., F.P.-V., J.G., J.D.), Department of Pathology, School of Medicine (F.O.), and CIBER-EHD, Center for Biomedical Research (CIBM) (J.G.), University of Granada, Spain; Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, Spain (M.R., R.J., F.O., J.G., J.D.); CIBER Enfermedades Cardiovasculares, Granada, Spain (R.J., J.D.); Department of Pharmacology, School of Medicine, University Complutense of Madrid, Spain (F.P.-V.); CIBER Enfermedades Respiratorias, Madrid, Spain (F.P.-V.); and Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain (F.P.-V.)
| | - Juan Duarte
- From the Department of Pharmacology, School of Pharmacy (M.R., M.T., I.R.-V., M.S., R.J., A.R.-N., F.P.-V., J.G., J.D.), Department of Pathology, School of Medicine (F.O.), and CIBER-EHD, Center for Biomedical Research (CIBM) (J.G.), University of Granada, Spain; Instituto de Investigación Biosanitaria de Granada, ibs.GRANADA, Spain (M.R., R.J., F.O., J.G., J.D.); CIBER Enfermedades Cardiovasculares, Granada, Spain (R.J., J.D.); Department of Pharmacology, School of Medicine, University Complutense of Madrid, Spain (F.P.-V.); CIBER Enfermedades Respiratorias, Madrid, Spain (F.P.-V.); and Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain (F.P.-V.).
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High Prevalence of Metabolic Syndrome in Patients with Discoid Lupus Erythematosus: A Cross-Sectional, Case-Control Study. J Immunol Res 2017; 2017:3972706. [PMID: 28127570 PMCID: PMC5239982 DOI: 10.1155/2017/3972706] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/07/2016] [Indexed: 02/06/2023] Open
Abstract
Although it is known that systemic form of lupus erythematosus (LE) and metabolic syndrome (MetS) are frequently observed together, there are no published reports on MetS in patients with skin-restricted LE. We aimed to compare the frequencies of MetS and its components in discoid LE (DLE) with the non-DLE control group. Additionally, we intended to determine the differences of sociodemographic and clinical data of the DLE patients with MetS compared to the patients without MetS. This was a cross-sectional, case-control study, including 60 patients with DLE and 82 age- and gender-matched control subjects. In DLE group, the presence of MetS was observed as more frequent (48.3% versus 24.4%, p = 0.003), and hypertriglyceridemia (43.3% versus 22.0%, p = 0.006) and reduced HDL-cholesterol (61.7% versus 23.2%, p < 0.001) among the MetS components were found significantly higher when compared to the control group. DLE patients with MetS were at older age (50.45 ± 11.49 versus 43.06 ± 12.09, p = 0.02), and hypertension, hyperlipidemia/dyslipidemia, and cardiovascular disease histories were observed at a higher ratio when compared to the patients without MetS. Between the DLE patients with and without MetS, no significant difference was observed in terms of clinical characteristics of DLE. Moreover, further large case-control studies with follow-up periods would be required to clearly assess the impact of MetS on the clinical outcomes of DLE.
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Sinicato NA, Peres FA, de Oliveira Peliçari K, de Oliveira Santos A, Ramos CD, Marini R, Appenzeller S. Comparison of estimates of body fat content in childhood-onset systemic lupus erythematosus. Lupus 2016; 26:417-425. [PMID: 27872396 DOI: 10.1177/0961203316673152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objective We aimed to compare estimates of body fat content with respect to their ability to predict the percentage of body fat, confirmed by dual-energy X-ray absorptiometry scans in childhood-onset systemic lupus erythematosus. Methods We included 64 consecutive childhood-onset systemic lupus erythematosus patients and 64 healthy age and sex-matched controls in a cross-sectional study. Anthropometric data, body mass index and body adiposity index were calculated for all subjects. Childhood-onset systemic lupus erythematosus patients were further assessed for clinical and laboratory childhood-onset systemic lupus erythematosus manifestations and fat mass, lean mass and percentage of body fat evaluated by dual-energy X-ray absorptiometry. Results Elevated waist/hip ratio was observed in childhood-onset systemic lupus erythematosus patients when compared to controls ( p < 0.001). We did not find differences between body mass index and body adiposity index classification in childhood-onset systemic lupus erythematosus patients and controls. Using dual-energy X-ray absorptiometry as gold standard we observed that all indirect estimates of body fat were correlated with whole body fat mass. We observed a correlation between height and cumulative corticosteroid dose adjusted by weight ( r = 0.429, p = 0.005) in childhood-onset systemic lupus erythematosus. On whole body analysis we observed a correlation between lean mass and ACR Damage Index scores ( r = -0.395; p = 0.019); percentage of body fat and adjusted Systemic Lupus Erythematosus Disease Activity Index ( r = 0.402; p = 0.008), disease duration ( r = -0.370; p = 0.012). On trunk analysis we observed a correlation between lean mass and ACR Damage Index ( r = -0.319; p = 0.042); percentage of body fat with adjusted Systemic Lupus Erythematosus Disease Activity Index ( r = 0.402; p = 0.005), disease duration ( r = -0.408; p = 0.005). Conclusions This is the first study analyzing body adiposity index in childhood-onset systemic lupus erythematosus patients. We observed that all indirect estimates of body fat were correlated with whole body fat mass. This study shows that we should not replace body mass index by body adiposity index to evaluating fat levels in childhood-onset systemic lupus erythematosus. In consideration of the importance of overweight classification in cardiovascular diseases, any direct estimates of body fat can be used in an attempt to improve the prognosis of patients. Note We believe that we have presented evidence of body adiposity index accuracy in childhood-onset systemic lupus erythematosus patients but further research on the generalizability of body adiposity index to other patient groups needs to be done.
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Affiliation(s)
- N A Sinicato
- 1 Postgraduate Program in Child And Adolescent's Health, Faculty of Medical Science, State University of Campinas, Brazil
| | - F A Peres
- 2 Department of Medicine-Postgraduate Program, Faculty of Medical Science, State University of Campinas, Brazil
| | - K de Oliveira Peliçari
- 2 Department of Medicine-Postgraduate Program, Faculty of Medical Science, State University of Campinas, Brazil
| | - A de Oliveira Santos
- 3 Department of Radiology, Nuclear Medicine Division, State University of Campinas, Brazil
| | - C D Ramos
- 3 Department of Radiology, Nuclear Medicine Division, State University of Campinas, Brazil
| | - R Marini
- 4 Pediatric Rheumatology, Department of Pediatrics, Faculty of Medical Science, State University of Campinas, Brazil
| | - S Appenzeller
- 4 Pediatric Rheumatology, Department of Pediatrics, Faculty of Medical Science, State University of Campinas, Brazil.,5 Rheumatology Unit, Department of Medicine, Faculty of Medical Science, State University of Campinas, Brazil
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Barnado A, Oeser A, Zhang Y, Okafor CR, Titze J, Stein CM, Chung CP. Association of estimated sodium and potassium intake with blood pressure in patients with systemic lupus erythematosus. Lupus 2016; 25:1463-1469. [PMID: 27055519 DOI: 10.1177/0961203316642311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Sodium and potassium intake are modifiable determinants of hypertension in the general population but have not been studied in patients with systemic lupus erythematosus (SLE). We examined the relationship between urinary excretion of sodium and potassium, as an estimate of intake, and blood pressure in patients with SLE. We studied 178 SLE patients and 86 controls, matched for age, sex, and race. Urine sodium (Na+) and potassium (K+) were measured by flame photometry. Blood pressure was the average of two resting measurements. The associations between systolic (SBP) and diastolic blood pressures (DBP) and estimated 24-hour urinary Na+, K+, and Na+:K+ ratio were tested. The estimated mean 24-hour urinary K+ excretion was lower, and the Na+:K+ ratio was higher in patients with SLE than controls. There were no significant differences in the estimated 24-hour urinary Na+. In patients with SLE, a higher urinary Na+:K+ ratio was associated with higher SBP (β coefficient = 4.01, p = 0.023) and DBP (β coefficient = 4.41, p = 0.002) after adjusting for age, sex, and race. SLE patients had significantly lower estimated 24-hour urinary K+ and higher estimated 24-hour urinary Na+: K+ ratio than controls. The urinary Na+:K+ ratio was significantly associated with SBP and DBP.
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Affiliation(s)
- A Barnado
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - A Oeser
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Y Zhang
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - C R Okafor
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - J Titze
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - C M Stein
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
| | - C P Chung
- Department of Medicine, Vanderbilt University, Nashville, TN, USA
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Why are kids with lupus at an increased risk of cardiovascular disease? Pediatr Nephrol 2016; 31:861-83. [PMID: 26399239 DOI: 10.1007/s00467-015-3202-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 08/14/2015] [Accepted: 08/25/2015] [Indexed: 01/12/2023]
Abstract
Juvenile-onset systemic lupus erythematosus (SLE) is an aggressive multisystem autoimmune disease. Despite improvements in outcomes for adult patients, children with SLE continue to have a lower life expectancy than adults with SLE, with more aggressive disease, a higher incidence of lupus nephritis and there is an emerging awareness of their increased risk of cardiovascular disease (CVD). In this review, we discuss the evidence for an increased risk of CVD in SLE, its pathogenesis, and the clinical approach to its management.
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Godoy-Gijón E, Meseguer-Yebra C, Palacio-Aller L, Godoy-Rocati DV, Lahoz-Rallo C. [New populations at increased cardiovascular risk: Cardiovascular disease in dermatological diseases]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2016; 28:143-153. [PMID: 26383179 DOI: 10.1016/j.arteri.2015.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 06/05/2023]
Abstract
The increased cardiovascular risk in some dermatological diseases has been demonstrated in recent decades. Diseases such as psoriasis and systemic lupus erythematosus are currently included in the guidelines for prevention of cardiovascular disease. Other diseases such as androgenic alopecia, polycystic ovary syndrome, hidradenitis suppurativa or lichen planus have numerous studies that point to an increased risk, however, they have not been included in these guidelines. In this article we review the evidence supporting this association, in order to alert the clinician to the need for greater control in cardiovascular risk factors in these patients.
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Affiliation(s)
- Elena Godoy-Gijón
- Servicio de Dermatología, Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - Carmen Meseguer-Yebra
- Servicio de Dermatología, Hospital Virgen de la Concha, Complejo Asistencial de Zamora, Zamora, España
| | | | | | - Carlos Lahoz-Rallo
- Unidad de Lípidos y Riesgo Vascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España
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Trujillo-Martín MM, Rúa-Figueroa Fernández de Larrinoa I, Ruíz-Irastorza G, Pego-Reigosa JM, Sabio Sánchez JM, Serrano-Aguilar P. [Clinical practice guidelines for systemic lupus erythematosus: Recommendations for general clinical management]. Med Clin (Barc) 2016; 146:413.e1-14. [PMID: 26975887 DOI: 10.1016/j.medcli.2016.01.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Revised: 01/13/2016] [Accepted: 01/21/2016] [Indexed: 12/22/2022]
Abstract
Systemic lupus erythematosus (SLE) is a complex rheumatic multisystemic disease of autoimmune origin with significant potential morbidity and mortality. It is one of the most common autoimmune diseases with an estimated prevalence of 20-150 cases per 100,000 inhabitants. The clinical spectrum of SLE is wide and variable both in clinical manifestations and severity. This prompted the Spanish Ministry of Health, Social Services and Equality to promote and fund the development of a clinical practice guideline (CPG) for the clinical care of SLE patients within the Programme of CPG in the National Health System which coordinates GuiaSalud. This CPG is is intended as the reference tool in the Spanish National Health System in order to support the comprehensive clinical management of people with SLE by all health professionals involved, regardless of specialty and level of care, helping to standardize and improve the quality of clinical decisions in our context in order to improve the health outcomes of the people affected. The purpose of this document is to present and discuss the rationale of the recommendations on the general management of SLE, specifically, clinical follow-up, general therapeutic approach, healthy lifestyles, photoprotection, and training programmes for patients. These recommendations are based on the best available scientific evidence, on discussion and the consensus of expert groups.
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Affiliation(s)
- María M Trujillo-Martín
- Fundación Canaria de Investigación Sanitaria (FUNCANIS), La laguna, Santa Cruz de Tenerife, España; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España
| | | | - Guillermo Ruíz-Irastorza
- Unidad de Investigación de Enfermedades Autoinmunes, Servicio de Medicina Interna, Hospital Universitario Cruces, Barakaldo, Vizcaya, España
| | - José María Pego-Reigosa
- Servicio de Reumatología, Hospital Meixoeiro, Vigo, España; IRIDIS (Investigation in Rheumatology and Immuno-Mediated Diseases) Group, Instituto de Investigación Biomédica (IBI) de Vigo, Pontevedra y Ourense, España
| | | | - Pedro Serrano-Aguilar
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, España; Servicio de Evaluación y Planificación (SESCS), Servicio Canario de la Salud, Santa Cruz de Tenerife, España
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23
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Metabolic syndrome in patients with systemic lupus erythematosus from South India. INDIAN JOURNAL OF RHEUMATOLOGY 2015. [DOI: 10.1016/j.injr.2015.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Castejon R, Jimenez-Ortiz C, Rosado S, Tutor-Ureta P, Mellor-Pita S, Yebra-Bango M. Metabolic syndrome is associated with decreased circulating endothelial progenitor cells and increased arterial stiffness in systemic lupus erythematosus. Lupus 2015; 25:129-36. [PMID: 26359174 DOI: 10.1177/0961203315603138] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 07/29/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Metabolic syndrome (MetS) is highly prevalent in patients with systemic lupus erythematosus (SLE) and it has been associated with increased cardiovascular risk. We examined the contribution of MetS to inflammatory markers, arterial stiffness and circulating endothelial progenitor cells (EPCs) as surrogates of subclinical atherosclerosis. METHODS Cardiovascular risk factors, SLE-specific factors and peripheral blood EPCs were assessed in 50 female SLE patients. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III. Simultaneously, atherosclerosis was assessed by measuring the carotid-femoral pulse wave velocity (PWV) by doppler velocimetry. RESULTS Beyond the factors included in the definition, SLE patients with MetS have a significantly higher serum level of uric acid (6.88 ± 2.20 vs 4.45 ± 1.17, p < 0.001) and some inflammatory biomarkers such as homocysteine, IL-8, sICAM-1 or complement molecules. The presence of MetS in our patients was closely linked with a significantly increased patient organ damage score (3.20 ± 1.97 vs 1.60 ± 1.67, p = 0.008), a decreased percentage of circulating EPCs (0.53 ± 0.24 vs 0.85 ± 0.57, p = 0.007) and an increased arterial stiffness (9.89 ± 2.40 vs 7.13 ± 1.51, p < 0.001). CONCLUSIONS MetS may contribute to the development of atherosclerosis by significantly increasing inflammation levels and arterial stiffness and decreasing circulating EPCs. This finding would justify close monitoring of these patients.
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Affiliation(s)
- R Castejon
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, University Hospital Puerta de Hierro Research Institute, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - C Jimenez-Ortiz
- Neurology Service, University Hospital Puerta de Hierro Research Institute, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - S Rosado
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, University Hospital Puerta de Hierro Research Institute, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - P Tutor-Ureta
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, University Hospital Puerta de Hierro Research Institute, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - S Mellor-Pita
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, University Hospital Puerta de Hierro Research Institute, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - M Yebra-Bango
- Systemic Autoimmune Diseases Unit, Internal Medicine Service, University Hospital Puerta de Hierro Research Institute, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
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Demir S, Artim-Esen B, Şahinkaya Y, Pehlivan Ö, Alpay-Kanıtez N, Omma A, Erer B, Kamalı S, Gül A, Aral O, Öcal L, İnanç M. Metabolic syndrome is not only a risk factor for cardiovascular diseases in systemic lupus erythematosus but is also associated with cumulative organ damage: a cross-sectional analysis of 311 patients. Lupus 2015; 25:177-84. [PMID: 26354963 DOI: 10.1177/0961203315603140] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 07/29/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND/PURPOSE Patients with systemic lupus erythematosus (SLE) have increased rates of cardiovascular disease (CVD) that are one of the major causes of mortality. The aim of this study was to determine the frequencies of metabolic syndrome (MetS) and CVD in SLE patients and investigate the link between these and clinical features of SLE. METHODS A total of 311 SLE patients were consecutively assessed for cumulative organ damage (SDI/SLICC scores), history of CVD and MetS as defined by the National Cholesterol Educational Program Adult Treatment Panel III (NCEP ATP III). Clinical data of SLE patients were collected from the records. RESULTS The mean age of the patients was 40.2 ± 13.4 years and 89% were female. The frequencies of CVD and MetS were 15.2% and 19%, respectively. In this SLE cohort increased age, cumulative damage, disease duration and CVD were associated with MetS. CVD was associated with disease duration, cumulative damage, pericarditis, hematologic involvement, lymphopenia, thrombocytopenia, neurological involvement and antiphospholipid antibody (aPL) positivity. Hydroxychloroquine (HCQ) use was found as a protective factor for CVD. CONCLUSION In SLE patients, MetS was associated with CVD and both increased with disease duration. Patients who developed MetS and/or CVD had increased cumulative organ damage. Certain clinical features of SLE and the presence of aPL were also associated with CVD. There was a significant protective effect of HCQ from CVD. The prevention of MetS and long-term use of HCQ may be beneficial in improving the prognosis of SLE.
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Affiliation(s)
- S Demir
- Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - B Artim-Esen
- Division of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Y Şahinkaya
- Division of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ö Pehlivan
- Division of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - N Alpay-Kanıtez
- Division of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - A Omma
- Division of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - B Erer
- Division of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - S Kamalı
- Division of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - A Gül
- Division of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - O Aral
- Division of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - L Öcal
- Division of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - M İnanç
- Division of Rheumatology, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
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26
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Muniz LF, Pereira RMR, Silva TF, Bonfá E, Borba EF. Impact of Therapy on Metabolic Syndrome in Young Adult Premenopausal Female Lupus Patients: Beneficial Effect of Antimalarials. Arthritis Care Res (Hoboken) 2015; 67:1255-1262. [DOI: 10.1002/acr.22593] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 02/18/2015] [Accepted: 03/24/2015] [Indexed: 12/30/2022]
Affiliation(s)
- Luciana F. Muniz
- Faculdade de Medicina da Universidade de Sao PauloSao Paulo Brazil
| | | | - Thiago F. Silva
- Faculdade de Medicina da Universidade de Sao PauloSao Paulo Brazil
| | - Eloisa Bonfá
- Faculdade de Medicina da Universidade de Sao PauloSao Paulo Brazil
| | - Eduardo F. Borba
- Faculdade de Medicina da Universidade de Sao PauloSao Paulo Brazil
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27
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Medeiros MMDC, Xavier de Oliveira ÍM, Ribeiro ÁTM. Prevalence of metabolic syndrome in a cohort of systemic lupus erythematosus patients from Northeastern Brazil: association with disease activity, nephritis, smoking, and age. Rheumatol Int 2015; 36:117-24. [PMID: 26149124 DOI: 10.1007/s00296-015-3316-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 06/26/2015] [Indexed: 01/21/2023]
Abstract
Systemic lupus erythematosus (SLE), an autoimmune inflammatory disease, is associated with an increased prevalence of accelerated atherosclerosis and cardiovascular events. Metabolic syndrome (MetS) is a set of cardiovascular risk factors in SLE patients, which may lead to a proinflammatory condition and increased morbidity and mortality. The objective of this study was to evaluate the prevalence of MetS in a cohort of SLE patients versus healthy controls, and to analyze the association of clinical and demographic factors. SLE patients (n = 146) treated at a Northeast Brazilian university hospital were evaluated with regard to demographic, clinical, laboratory, and anthropometric parameters and compared to controls (n = 101). MetS was diagnosed according to the definition of 2005 NCEP/ATP III. The average age of SLE patients was 41.7 ± 12.5 years, and 91.8 % were female. MetS was significantly more prevalent in SLE patients (45.2 %) than in controls (32.7 %; p = 0.04). The MetS components such as hypertension, diabetes, and hypertriglyceridemia were significantly more prevalent in SLE. In the univariate analysis, MetS in SLE patients was associated with age, disease duration, Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index, smoking, menopause, nephritis, cyclophosphamide use, prednisone dose, and chloroquine use, which appeared to have a protective effect. In the logistic regression analysis, age, disease activity, nephritis, and smoking were statistically significant. The prevalence of MetS observed in our cohort of SLE patients from Northeastern Brazil is higher than controls. MetS components should be routinely investigated to minimize the occurrence of MetS and associated cardiovascular morbidity and mortality.
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Affiliation(s)
- Marta Maria das Chagas Medeiros
- Department of Clinical Medicine, Federal University of Ceara, Fortaleza, Ceará, Brazil. .,, Av. Litoranea 2040- Casa K2-1, Bairro Precabura, Eusébio, Ceará, CEP: 61760-000, Brazil.
| | - Ídila Mont'Alverne Xavier de Oliveira
- Hospital Universitario Walter Cantidio, Federal University of Ceará, Fortaleza, Ceará, Brazil. .,, Av. Imperador 1772/504, Centro, Fortaleza, Ceará, CEP: 60015-051, Brazil.
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Erdozain JG, Ruiz Irastorza G. [Metabolic syndrome in patients with systemic lupus erythematosus: causes and consequences]. Med Clin (Barc) 2015; 144:309-11. [PMID: 25434856 DOI: 10.1016/j.medcli.2014.09.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 09/25/2014] [Indexed: 12/28/2022]
Affiliation(s)
- Jose Gabriel Erdozain
- Unidad de Investigación de Enfermedades Autoinmunes, Servicio de Medicina Interna, Biocruces Health Research Institute, Hospital Universitario de Cruces, Universidad del País Vasco/Euskal Herriko Unibertsitatea, Barakaldo, Bizkaia, España
| | - Guillermo Ruiz Irastorza
- Unidad de Investigación de Enfermedades Autoinmunes, Servicio de Medicina Interna, Biocruces Health Research Institute, Hospital Universitario de Cruces, Universidad del País Vasco/Euskal Herriko Unibertsitatea, Barakaldo, Bizkaia, España.
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Baraka E, El Dein M, Farouk H, El Moutaz Y. Hyperhomocysteinemia and metabolic syndrome are risk factors for sub-clinical atherosclerosis in women with systemic lupus erythematosus. EGYPTIAN RHEUMATOLOGIST 2015. [DOI: 10.1016/j.ejr.2014.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Sabio JM, Vargas-Hitos JA, Martinez-Bordonado J, Navarrete-Navarrete N, Díaz-Chamorro A, Olvera-Porcel C, Zamora-Pasadas M, Jiménez-Alonso J. Relationship between homocysteine levels and hypertension in systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2015; 66:1528-35. [PMID: 24692389 DOI: 10.1002/acr.22340] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Accepted: 03/25/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Homocysteine has been linked to atherosclerosis and hypertension (HT) in the general population. However, there is limited evidence regarding the effect of homocysteine on blood pressure and arterial stiffness in systemic lupus erythematosus (SLE). We examined whether homocysteine is associated with HT and arterial stiffness in women with SLE. METHODS In total, 99 women with SLE without a history of cardiovascular disease or diabetes mellitus and 101 matched controls were included in this cross-sectional study. Participants were analyzed for homocysteine levels, cardiovascular risk factors, and arterial stiffness assessed by means of carotid-femoral pulse wave velocity (PWV). Associations between homocysteine, systolic blood pressure (SBP), PWV, and HT were tested using univariate and multivariate analyses. RESULTS Homocysteine levels (mean ± SD 12.3 ± 4.8 versus 9.3 ± 3.8 μmoles/liter), PWV (mean ± SD 7.54 ± 1.1 versus 7.10 ± 1.1 meters/second), SBP (mean ± SD 119 ± 13 versus 115 ± 12 mm Hg), and the prevalence of hyperhomocysteinemia (23% versus 7%) and HT (43% versus 12%) were significantly higher in women with SLE (P < 0.050 for all). In the univariate analysis, homocysteine correlated positively with SBP (P = 0.001) and PWV (P = 0.023) in women with SLE but not in controls. In the multiple linear regression analysis, SBP was independently associated with homocysteine and body mass index (BMI) in women with SLE. Similarly, in the multivariate logistic regression analysis, homocysteine levels (or hyperhomocysteinemia), BMI, and daily prednisone dose were independently associated with HT in women with SLE. CONCLUSION Homocysteine was independently associated with SBP and HT in women with SLE, but not in controls. Elevated homocysteine levels could increase the risk of HT in SLE.
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Barsalou J, Bradley TJ, Silverman ED. Cardiovascular risk in pediatric-onset rheumatological diseases. Arthritis Res Ther 2014; 15:212. [PMID: 23731870 PMCID: PMC3672705 DOI: 10.1186/ar4212] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular morbidity and mortality are becoming major health concerns for adults with inflammatory rheumatic diseases. The enhanced atherogenesis in this patient population is promoted by the exposure to traditional risk factors as well as nontraditional cardiovascular insults, such as corticosteroid therapy, chronic inflammation and autoantibodies. Despite definite differences between many adult-onset and pediatric-onset rheumatologic diseases, it is extremely likely that atherosclerosis will become the leading cause of morbidity and mortality in this pediatric patient population. Because cardiovascular events are rare at this young age, surrogate measures of atherosclerosis must be used. The three major noninvasive vascular measures of early atherosclerosis--namely, flow-mediated dilatation, carotid intima-media thickness and pulse wave velocity--can be performed easily on children. Few studies have explored the prevalence of cardiovascular risk factors and even fewer have used the surrogate vascular measures to document signs of early atherosclerosis in children with pediatric-onset rheumatic diseases. The objective of this review is to provide an overview on cardiovascular risk and early atherosclerosis in pediatric-onset systemic lupus erythematosus, juvenile idiopathic arthritis and juvenile dermatomyositis patients, and to review cardiovascular preventive strategies that should be considered in this population.
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Sabio JM, Vargas-Hitos JA, Martinez-Bordonado J, Navarrete-Navarrete N, Díaz-Chamorro A, Olvera-Porcel C, Zamora M, Jiménez-Alonso J. Association between low 25-hydroxyvitamin D, insulin resistance and arterial stiffness in nondiabetic women with systemic lupus erythematosus. Lupus 2014; 24:155-63. [DOI: 10.1177/0961203314551811] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective The objective of this paper is to examine if there is an association between low levels of 25-hydroxyvitamin D (25(OH)D) and insulin resistance (IR) in nondiabetic women with systemic lupus erythematosus (SLE) and to evaluate its impact on arterial stiffness. Patients and methods In this cross-sectional study 25(OH)D, insulin, insulin resistance measured by the homeostatic model assessment (HOMA-IR), homocysteine, fibrinogen, characteristics of SLE, medications and pulse-wave velocity (PWV) were measured in 106 nondiabetic women with SLE and 101 matched controls. Results Women with SLE tended to have lower 25(OH)D levels ( p = 0.078) and a higher frequency of 25(OH)D deficiency (defined as <10 ng/ml) than controls ( p = 0.058). Patients from the lowest quartile of the 25(OH)D range had higher PWV ( p = 0.043), fasting glucose ( p = 0.035), insulinemia ( p ≤ 0.001), HOMA-IR ( p = 0.006), C4 ( p = 0.012), as well as more frequent IR ( p = 0.002) and metabolic syndrome ( p = 0.052) than those in the upper quartile, and no differences were found in age, body mass index (BMI), blood pressure, lipid levels and renal function. In women with SLE, 25(OH)D inversely correlated with insulin ( p = 0.006), HOMA-IR ( p = 0.008) and C4 ( p = 0.048) and tended to correlate with fibrinogen ( p = 0.060) after adjustment for BMI, age, SLEDAI, prednisone dose, renal function, inflammation markers and seasonal variation, but not with PWV. In controls, 25(OH)D correlated only with homocysteine after the same adjustment, and the correlation with PWV tended to be significant after adjustment for BMI and age ( r = −0.190, p = 0.10). Conclusion Low 25(OH)D levels were found to be associated with increased IR in nondiabetic women with SLE independently of BMI. Low 25(OH)D levels, but not IR, could be associated with increased arterial stiffness in these patients.
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Affiliation(s)
- J M Sabio
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain
| | - J A Vargas-Hitos
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain
| | - J Martinez-Bordonado
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain
| | - N Navarrete-Navarrete
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain
| | - A Díaz-Chamorro
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain
| | - C Olvera-Porcel
- Department of Statistics, Fundación para la Investigación Biosanitaria de Andalucía Oriental (FIBAO), Granada, Spain
| | - M Zamora
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain
| | - J Jiménez-Alonso
- Systemic Autoimmune Diseases Unit, Department of Internal Medicine, University Hospital Virgen de las Nieves, Granada, Spain
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[Atherosclerosis in systemic lupus erythematosus]. Presse Med 2014; 43:1034-47. [PMID: 25201598 DOI: 10.1016/j.lpm.2014.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 01/17/2014] [Accepted: 01/23/2014] [Indexed: 11/20/2022] Open
Abstract
CONTEXT Evidence from epidemiological studies demonstrates that patients with systemic lupus erythematosus (SLE) are at increased risk for the development of cardiovascular disease. Traditional cardiovascular risk factors' play an important role in this phenomenon but do not account for the entire risk in lupus patients. OBJECTIVES The incidence and prevalence of cardiovascular events and infraclinical atherosclerosis are reviewed. Combinations of traditional risk factors with lupus-specific and treatment-related variables are detailed. RESULTS Atherosclerosis is more prevalent and occurs prematurely in lupus patients. Relative risk of myocardial infarction is between 5 to 8 times greater that of general population, and may exceed 50 in women between 35 and 44 years old. SLE was also found as an independent risk factor for subclinical atherosclerosis, and more than one third of lupus patient show evidence of carotid plaques of coronary artery calcifications. Lupus patients have more frequent traditional risk factors compared with general population of similar age and sex. Besides the traditional risk factors, SLE specific risk factors have been identified among witch advanced age at diagnosis, current disease activity, duration of the disease and renal activity. Moreover, lipid abnormalities in patients with SLE are common and likely are one of the major causes of premature atherosclerosis in these patients; the dyslipoprotein associated increased triglycerides and depressed HDL-cholesterol with proinflammatory HDL production. Autoimmunity may have a part of responsibility, but data's in favour of this hypothesis are not strong. Other mechanisms such as vascular inflammation, oxidative stress, immune complexes and complement activation may also elicit endothelial damage and promote atherosclerosis are associated with the pathogenesis of both SLE and atherosclerosis. Steroids may have a true double-edged role with a pro-atherogenic risk regarding the exacerbation of metabolic risk factors and a "beneficial" anti-inflammatory role. It is becoming increasingly apparent that antimalarials treatment in SLE has an atheroprotective and a cardioprotective effect. The other immunosuppressive drugs may reduce progression of atherosclerosis and cardiovascular events but their precise role remains to be elucidated. Despite their role in primary prevention in target general population, for now, systematic prescription of statins does not show a great benefit in the cardiovascular risk in lupus patients. CONCLUSION Mechanisms of atherosclerosis in SLE remain elusive. It is partially explained by the interaction of traditional cardiovascular risk factors, lupus-specific factors and therapy specially corticosteroids. Management strategies of lupus should include early all those items.
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Gómez-Guzmán M, Jiménez R, Romero M, Sánchez M, Zarzuelo MJ, Gómez-Morales M, O'Valle F, López-Farré AJ, Algieri F, Gálvez J, Pérez-Vizcaino F, Sabio JM, Duarte J. Chronic hydroxychloroquine improves endothelial dysfunction and protects kidney in a mouse model of systemic lupus erythematosus. Hypertension 2014; 64:330-7. [PMID: 24842914 DOI: 10.1161/hypertensionaha.114.03587] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Hydroxychloroquine has been shown to be efficacious in the treatment of autoimmune diseases, including systemic lupus erythematosus. Hydroxychloroquine-treated lupus patients showed a lower incidence of thromboembolic disease. Endothelial dysfunction, the earliest indicator of the development of cardiovascular disease, is present in lupus. Whether hydroxychloroquine improves endothelial function in lupus is not clear. The aim of this study was to analyze the effects of hydroxychloroquine on hypertension, endothelial dysfunction, and renal injury in a female mouse model of lupus. NZBWF1 (lupus) and NZW/LacJ (control) mice were treated with hydroxychloroquine 10 mg/kg per day by oral gavage, or with tempol and apocynin in the drinking water, for 5 weeks. Hydroxychloroquine treatment did not alter lupus disease activity (assessed by plasma double-stranded DNA autoantibodies) but prevented hypertension, cardiac and renal hypertrophy, proteinuria, and renal injury in lupus mice. Aortae from lupus mice showed reduced endothelium-dependent vasodilator responses to acetylcholine and enhanced contraction to phenylephrine, which were normalized by hydroxychloroquine or antioxidant treatments. No differences among all experimental groups were found in both the relaxant responses to acetylcholine and the contractile responses to phenylephrine in rings incubated with the nitric oxide synthase inhibitor N(G)-nitro-l-arginine methyl ester. Vascular reactive oxygen species content and mRNA levels of nicotinamide adenine dinucleotide phosphate oxidase subunits NOX-1 and p47(phox) were increased in lupus mice and reduced by hydroxychloroquine or antioxidants. Chronic hydroxychloroquine treatment reduced hypertension, endothelial dysfunction, and organ damage in severe lupus mice, despite the persistent elevation of anti-double-stranded DNA, suggesting the involvement of new additional mechanisms to improve cardiovascular complications.
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Affiliation(s)
- Manuel Gómez-Guzmán
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Rosario Jiménez
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Miguel Romero
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Manuel Sánchez
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - María José Zarzuelo
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Mercedes Gómez-Morales
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Francisco O'Valle
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Antonio José López-Farré
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Francesca Algieri
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Julio Gálvez
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Francisco Pérez-Vizcaino
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - José Mario Sabio
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.)
| | - Juan Duarte
- From the Department of Pharmacology (M.G.-G., R.J., M.R., M.S., M.J.Z., J.D.), CIBERehd (F.A., J.G.), and Department of Pathology (M.G.-M., F.O.), University of Granada, Granada, Spain; Cardiovascular Research Unit, Hospital Clínico San Carlos (A.J.L.-F.), Department of Pharmacology, School of Medicine, Complutense University of Madrid; Ciber Enfermedades Respiratorias (Ciberes), and Instituto de Investigacion Sanitaria Gregorio Maranon (IISGM), Madrid, Spain (F.P.-V.); Internal Medicine Service, Hospital Universitario Virgen de las Nieves, Granada, Spain (J.M.S.).
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Parker B, Urowitz MB, Gladman DD, Lunt M, Donn R, Bae SC, Sanchez-Guerrero J, Romero-Diaz J, Gordon C, Wallace DJ, Clarke AE, Bernatsky S, Ginzler EM, Isenberg DA, Rahman A, Merrill JT, Alarcón GS, Fessler BJ, Fortin PR, Hanly JG, Petri M, Steinsson K, Dooley MA, Manzi S, Khamashta MA, Ramsey-Goldman R, Zoma AA, Sturfelt GK, Nived O, Aranow C, Mackay M, Ramos-Casals M, van Vollenhoven RF, Kalunian KC, Ruiz-Irastorza G, Lim SS, Kamen DL, Peschken CA, Inanc M, Bruce IN. Impact of early disease factors on metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort. Ann Rheum Dis 2014; 74:1530-6. [PMID: 24692585 PMCID: PMC4515988 DOI: 10.1136/annrheumdis-2013-203933] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 03/16/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND The metabolic syndrome (MetS) may contribute to the increased cardiovascular risk in systemic lupus erythematosus (SLE). We examined the association between MetS and disease activity, disease phenotype and corticosteroid exposure over time in patients with SLE. METHODS Recently diagnosed (<15 months) patients with SLE from 30 centres across 11 countries were enrolled into the Systemic Lupus International Collaborating Clinics (SLICC) Inception Cohort from 2000 onwards. Baseline and annual assessments recorded clinical, laboratory and therapeutic data. A longitudinal analysis of factors associated with MetS in the first 2 years of follow-up was performed using random effects logistic regression. RESULTS We studied 1150 patients with a mean (SD) age of 34.9 (13.6) years and disease duration at enrolment of 24.2 (18.0) weeks. In those with complete data, MetS prevalence was 38.2% at enrolment, 34.8% at year 1 and 35.4% at year 2. In a multivariable random effects model that included data from all visits, prior MetS status, baseline renal disease, SLICC Damage Index >1, higher disease activity, increasing age and Hispanic or Black African race/ethnicity were independently associated with MetS over the first 2 years of follow-up in the cohort. CONCLUSIONS MetS is a persistent phenotype in a significant proportion of patients with SLE. Renal lupus, active inflammatory disease and damage are SLE-related factors that drive MetS development while antimalarial agents appear to be protective from early in the disease course.
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Affiliation(s)
- Ben Parker
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Toronto, Ontario, Canada
| | - Murray B Urowitz
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Dafna D Gladman
- Centre for Prognosis Studies in the Rheumatic Diseases, Toronto Western Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Mark Lunt
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Toronto, Ontario, Canada
| | - Rachelle Donn
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
| | - Sang-Cheol Bae
- Department of Rheumatology, Hanyang University Hospital for Rheumatic Diseases, Seoul, Korea
| | | | | | - Caroline Gordon
- Rheumatology Research Group, School of Immunity and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Daniel J Wallace
- Cedars-Sinai/David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ann E Clarke
- Divisions of Clinical Immunology/Allergy and Clinical Epidemiology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sasha Bernatsky
- Divisions of Clinical Immunology/Allergy and Clinical Epidemiology, Montreal General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Ellen M Ginzler
- Department of Medicine, SUNY Downstate Medical Center, Brooklyn, New York, USA
| | - David A Isenberg
- Centre for Rheumatology Research, University College, London, UK
| | - Anisur Rahman
- Centre for Rheumatology Research, University College, London, UK
| | - Joan T Merrill
- Department of Clinical Pharmacology, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma, USA
| | - Graciela S Alarcón
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Barri J Fessler
- Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Paul R Fortin
- Division of Rheumatology, Centre Hospitalier Universitaire de Québec et Université Laval, Quebec City, Quebec, Canada
| | - John G Hanly
- Division of Rheumatology, Department of Medicine and Department of Pathology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michelle Petri
- Department of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kristjan Steinsson
- Center for Rheumatology Research, Landspitali University hospital, Reykjavik, Iceland
| | - Mary Anne Dooley
- Division of Rheumatology and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Susan Manzi
- Lupus Center of Excellence, Allegheny Health Network, Pittsburgh, Pennsylvania, USA
| | - Munther A Khamashta
- Lupus Research Unit, The Rayne Institute, St Thomas' Hospital, King's College London School of Medicine, London, UK
| | | | - Asad A Zoma
- Lanarkshire Centre for Rheumatology, Hairmyres Hospital, East Kilbride, UK
| | | | - Ola Nived
- Department of Rheumatology, University Hospital Lund, Lund, Sweden
| | - Cynthia Aranow
- Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Meggan Mackay
- Feinstein Institute for Medical Research, Manhasset, New York, USA
| | - Manuel Ramos-Casals
- Department of Autoimmune Diseases, Josep Font Autoimmune Diseases Laboratory, IDIBAPS, Hospital Clínic, Barcelona, Spain
| | | | | | - Guillermo Ruiz-Irastorza
- Autoimmune Disease Unit, Department of Internal Medicine, Hospital Universitario Cruces, University of the Basque Country, Barakaldo, Spain
| | - S Sam Lim
- Emory University, Atlanta, Georgia, USA
| | - Diane L Kamen
- Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Murat Inanc
- Division of Rheumatology, Department of Internal Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Ian N Bruce
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Toronto, Ontario, Canada
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Abella V, Scotece M, Conde J, López V, Lazzaro V, Pino J, Gómez-Reino JJ, Gualillo O. Adipokines, metabolic syndrome and rheumatic diseases. J Immunol Res 2014; 2014:343746. [PMID: 24741591 PMCID: PMC3987880 DOI: 10.1155/2014/343746] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/10/2014] [Accepted: 01/10/2014] [Indexed: 02/06/2023] Open
Abstract
The metabolic syndrome (MetS) is a cluster of cardiometabolic disorders that result from the increasing prevalence of obesity. The major components of MetS include insulin resistance, central obesity, dyslipidemia, and hypertension. MetS identifies the central obesity with increased risk for cardiovascular diseases (CVDs) and type-2 diabetes mellitus (T2DM). Patients with rheumatic diseases, such as rheumatoid arthritis, osteoarthritis, systemic lupus erythematosus, and ankylosing spondylitis, have increased prevalence of CVDs. Moreover, CVD risk is increased when obesity is present in these patients. However, traditional cardiovascular risk factors do not completely explain the enhanced cardiovascular risk in this population. Thus, MetS and the altered secretion patterns of proinflammatory adipokines present in obesity could be the link between CVDs and rheumatic diseases. Furthermore, adipokines have been linked to the pathogenesis of MetS and its comorbidities through their effects on vascular function and inflammation. In the present paper, we review recent evidence of the role played by adipokines in the modulation of MetS in the general population, and in patients with rheumatic diseases.
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Affiliation(s)
- Vanessa Abella
- SERGAS, Research Laboratory 9, NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Institute of Medical Research (IDIS), Santiago University Clinical Hospital, 15706 Santiago de Compostela, Spain ; Department of Molecular and Cellular Biology, University of Coruña (UDC), 15071 A Coruña, Spain
| | - Morena Scotece
- SERGAS, Research Laboratory 9, NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Institute of Medical Research (IDIS), Santiago University Clinical Hospital, 15706 Santiago de Compostela, Spain
| | - Javier Conde
- SERGAS, Research Laboratory 9, NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Institute of Medical Research (IDIS), Santiago University Clinical Hospital, 15706 Santiago de Compostela, Spain
| | - Verónica López
- SERGAS, Research Laboratory 9, NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Institute of Medical Research (IDIS), Santiago University Clinical Hospital, 15706 Santiago de Compostela, Spain
| | - Verónica Lazzaro
- SERGAS, Research Laboratory 9, NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Institute of Medical Research (IDIS), Santiago University Clinical Hospital, 15706 Santiago de Compostela, Spain ; University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Jesús Pino
- SERGAS, Division of Orthopaedics Surgery and Traumatology, Santiago University Clinical Hospital, 15706 Santiago de Compostela, Spain
| | - Juan J Gómez-Reino
- SERGAS, Research Laboratory 9, NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Institute of Medical Research (IDIS), Santiago University Clinical Hospital, 15706 Santiago de Compostela, Spain
| | - Oreste Gualillo
- SERGAS, Research Laboratory 9, NEIRID Lab (Neuroendocrine Interactions in Rheumatology and Inflammatory Diseases), Institute of Medical Research (IDIS), Santiago University Clinical Hospital, 15706 Santiago de Compostela, Spain
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Parra S, Cabré A, Marimon F, Ferré R, Ribalta J, Gonzàlez M, Heras M, Castro A, Masana L. Circulating FABP4 is a marker of metabolic and cardiovascular risk in SLE patients. Lupus 2014; 23:245-54. [DOI: 10.1177/0961203313517405] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The aim of this study is to determine if circulating fatty acid-binding protein 4 (FABP4) plasma levels are a possible marker of metabolic risk in SLE patients. Circulating levels of adipose FABP4 are associated with adiposity, insulin resistance (IR), metabolic syndrome, diabetes and cardiovascular diseases. Patients affected by systemic lupus erythematosus (SLE) show an accelerated atherosclerosis that cannot be entirely explained by traditional cardiovascular risk factors. Sixty consecutive patients with SLE and 34 non-SLE age-matched controls were recruited for the study. Total plasma lipids and circulating FABP4 were determined. Subclinical atherosclerosis was evaluated by measuring carotid intimae-media thickness (c-IMT) by sonography, and the distribution of lipoprotein subclasses was analysed by nuclear magnetic resonance (NMR) spectroscopy. In the SLE group, FABP4 was associated with IR, atherogenic dyslipidaemia, as measured by NMR, and the presence of subclinical atherosclerosis. In multivariate analyses FABP4 was associated with increased c-IMT independent of the inflammatory state of the patient. In sum, circulating FABP4 is involved in the metabolic disturbances of SLE affecting lipid metabolism and IR, and it could be a biomarker of atherosclerosis in this population.
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Affiliation(s)
- S Parra
- Internal Medicine Department, “Sant Joan” University Hospital (Reus-Spain), Institut Investigació Sanitaria Pere Virgili (IISPV), Universitat Rovira i Virgili, Reus, Spain
- Grupo de Enfermedades Autoinmunes Sistémicas (GEAS), Sociedad Española de Medicina Interna (SEMI), Spain
| | - A Cabré
- URLA, CIBERDEM, “Sant Joan” University Hospital (Reus-Spain), IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - F Marimon
- Internal Medicine Department, “Sant Joan” University Hospital (Reus-Spain), Institut Investigació Sanitaria Pere Virgili (IISPV), Universitat Rovira i Virgili, Reus, Spain
| | - R Ferré
- Internal Medicine Department, “Sant Joan” University Hospital (Reus-Spain), Institut Investigació Sanitaria Pere Virgili (IISPV), Universitat Rovira i Virgili, Reus, Spain
- Unitat de Medicina Vascular i Metabolisme (UVASMET), Unitat de Recerca de Lipids i Arteriosclerosis (URLA), “Sant Joan” University Hospital (Reus-Spain), Internal Medicine, IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - J Ribalta
- URLA, CIBERDEM, “Sant Joan” University Hospital (Reus-Spain), IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - M Gonzàlez
- URLA, CIBERDEM, “Sant Joan” University Hospital (Reus-Spain), IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - M Heras
- URLA, CIBERDEM, “Sant Joan” University Hospital (Reus-Spain), IISPV, Universitat Rovira i Virgili, Reus, Spain
| | - A Castro
- Internal Medicine Department, “Sant Joan” University Hospital (Reus-Spain), Institut Investigació Sanitaria Pere Virgili (IISPV), Universitat Rovira i Virgili, Reus, Spain
- Grupo de Enfermedades Autoinmunes Sistémicas (GEAS), Sociedad Española de Medicina Interna (SEMI), Spain
| | - L Masana
- Internal Medicine Department, “Sant Joan” University Hospital (Reus-Spain), Institut Investigació Sanitaria Pere Virgili (IISPV), Universitat Rovira i Virgili, Reus, Spain
- Unitat de Medicina Vascular i Metabolisme (UVASMET), Unitat de Recerca de Lipids i Arteriosclerosis (URLA), “Sant Joan” University Hospital (Reus-Spain), Internal Medicine, IISPV, Universitat Rovira i Virgili, Reus, Spain
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Ruiz-Irastorza G, Danza A, Khamashta M. Tratamiento del lupus eritematoso sistémico: mitos, certezas y dudas. Med Clin (Barc) 2013; 141:533-42. [DOI: 10.1016/j.medcli.2013.02.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 02/14/2013] [Indexed: 02/08/2023]
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Abstract
Metabolic syndrome (MetS) is a recently defined clustering of cardiovascular risk factors associated with insulin resistance and an increased risk of future type II diabetes mellitus and cardiovascular disease (CVD). Systemic lupus erythematosus (SLE) patients have an increased prevalence of MetS and an increased prevalence of insulin resistance. Chronic inflammation may predispose to these complications in SLE and there is also evidence that corticosteroid therapy also contributes, although this finding has not been as consistent as would be predicted from the known metabolic effects of corticosteroids. MetS may represent a good model in which to begin to understand how SLE drives an increased risk of CVD. For now, the utility of identifying MetS in patients is to identify a subset in which more focused lifestyle interventions should be targeted and in whom medication review and adjustment (especially corticosteroid doses) should be considered to help modify future CVD risk.
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Affiliation(s)
- B Parker
- Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, UK
| | - IN Bruce
- Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, and Kellgren Centre for Rheumatology, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, UK
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Abstract
Ischemic stroke is increased in systemic lupus erythematosus (SLE) patients. The differential diagnosis of stroke in SLE is complex. Transient ischemic attack and ischemic stroke share pathophysiologic mechanisms, but prognosis may vary depending on severity and cause, and definitions are dependent on the timing and extent of the diagnostic evaluation. In SLE patients with a history of transient ischemic attacks, stroke occurred in 57%. Cerebrovascular events account for 20% to 30% of deaths in patients with SLE. In SLE, both disease-specific and traditional stroke risk factors are important.
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Affiliation(s)
- H Timlin
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - M Petri
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
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da Silva TF, Levy-Neto M, Bonfá E, Pereira RMR. High prevalence of metabolic syndrome in Takayasu arteritis: increased cardiovascular risk and lower adiponectin serum levels. J Rheumatol 2013; 40:1897-904. [PMID: 24037555 DOI: 10.3899/jrheum.130162] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The prevalence of metabolic syndrome (MetS) tends to be high among rheumatic patients, and cardiovascular disease is the leading cause of death in these conditions. We aimed to determine the prevalence of MetS in patients with Takayasu arteritis (TA) and its association with risk factors and adipokine and cytokine levels. METHODS A cross-sectional study was conducted in 45 consecutive women with TA and 47 healthy controls matched by age and body mass index. RESULTS The prevalence of MetS (International Diabetes Federation/American Heart Association criteria) was higher in TA compared to controls (33.34 vs 8.51%, p = 0.003). Patients with TA had a higher frequency of hypertension (p < 0.001) and dyslipidemia (p = 0.001) and higher levels of insulin (p = 0.021), homeostasis model assessment index (p = 0.024), apolipoprotein E (p = 0.029), resistin (p = 0.018), and C-reactive protein (CRP, p < 0.001) compared to healthy subjects, with similar levels of adiponectin and plasminogen activator inhibitor-1 (PAI-1; p > 0.05). Further analysis of patients with TA with and without MetS revealed a higher frequency of overweight/obesity (66.66 vs 26.66%, p = 0.022), higher Framingham score ≥ 1 (p = 0.032), and lower adiponectin levels (20.37 ± 21.16 vs 38.64 ± 22.62 μg/ml, p = 0.022) in the patients with MetS. No differences were found regarding disease duration, activity, glucocorticoid use, resistin, and PAI-1 levels in the 2 groups of patients with TA (p > 0.05). Patients with and without MetS showed no differences in cytokine levels [interleukin 12 (IL-12, IL-1a, IL-6) and tumor necrosis factor-α]. IL-6 had a positive Pearson correlation with CRP only in TA patients with MetS (r = 0.57; p = 0.050). CONCLUSION A high prevalence of MetS was observed in patients with TA and this comorbidity seems to identify a subgroup of overweight/obese patients with high cardiovascular risk without a significant association with disease status. Further longitudinal studies are necessary to observe the effects of controlling this modifiable risk factor in the quality of life and survival of patients with TA.
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Affiliation(s)
- Thiago Ferreira da Silva
- From the Rheumatology Division, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Sinicato NA, da Silva Cardoso PA, Appenzeller S. Risk factors in cardiovascular disease in systemic lupus erythematosus. Curr Cardiol Rev 2013; 9:15-9. [PMID: 23463953 PMCID: PMC3584302 DOI: 10.2174/157340313805076304] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 07/03/2012] [Accepted: 08/17/2012] [Indexed: 12/13/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic and multisystemic autoimmune disorder which predominantly affecting women. The most common cause of death in SLE patients affected by disease for more than 5 years is cardiovascular disease (CVD). Epidemiological observations suggest that, together with classical conventional risk factors, other mechanisms (non-conventional/disease-specific factors) promote accelerated atherosclerosis in inflammatory diseases like SLE. Traditional CVD risk factors included age, hypertension, diabetes mellitus, dyslipidemia, previous vascular event defined as previous history of cerebrovascular accidents or ischemic heart disease, menopause and smoking. The non-traditional factors presents in SLE are disease-specific like renal disease manifestation as Lupus nephritis (LN), presence of pro-inflammatory cytokines, some of inflammatory mediators, antiphospholipid antibodies, anti-oxLDL antibodies, corticosteroid uses and cumulative dose of glucocorticoids. We will review traditional and non-traditional risk factors associated with CVD in SLE patients.
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Affiliation(s)
- Nailú Angélica Sinicato
- Department of Medicine, Rheumatology Unit, Faculty of Medical Science, State University of Campinas, Cidade Universitária, Campinas SP, Brazil
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de Moraes MT, de Souza FHC, de Barros TBM, Shinjo SK. Analysis of Metabolic Syndrome in Adult Dermatomyositis With a Focus on Cardiovascular Disease. Arthritis Care Res (Hoboken) 2013; 65:793-9. [DOI: 10.1002/acr.21879] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 10/05/2012] [Indexed: 11/06/2022]
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Akhavan PS, Su J, Lou W, Gladman DD, Urowitz MB, Fortin PR. The early protective effect of hydroxychloroquine on the risk of cumulative damage in patients with systemic lupus erythematosus. J Rheumatol 2013; 40:831-41. [PMID: 23588942 DOI: 10.3899/jrheum.120572] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess whether hydroxychloroquine (HCQ) prevents early damage in patients with systemic lupus erythematosus (SLE). METHODS We updated an existing systematic review of literature on clinical effects of HCQ in patients with SLE. We conducted a nested case-control study embedded in an inception cohort of patients with SLE. Systemic Lupus International Collaborating Clinics Damage Index (SDI) at 3 years was considered as our primary outcome. Patients with SDI > 0 at 3 years were considered cases and patients with SDI = 0 were controls. Cases and controls were first compared by univariate analysis. Then conditional logistic regression models adjusting for potential confounders were done to study the effect of HCQ on damage accrual. RESULTS Included in the analysis were 481 patients who had 3 or more years of followup. Out of this cohort, we could match 151 cases with 151 controls. Univariate analysis identified age, the use of any immunosuppressive drugs, HCQ, and cumulative dose of steroids as significant covariates associated with damage accrual. In multivariate analysis, the use of HCQ remained significantly associated with less damage (OR 0.34, 95% CI 0.132-0.867), while age (OR 1.05, 95% CI 1.027-1.078) and a variable combining SLE activity and steroid dose (OR 1.73, 95% CI 1.306-2.295) were associated with damage at 3 years. CONCLUSION We demonstrated that HCQ use was associated with less damage at 3 years after diagnosis of SLE when attention was given and adjustment done for disease activity and steroid dose, duration of disease, and calendar year of diagnosis.
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Affiliation(s)
- Pooneh S Akhavan
- Division of Rheumatology, Department of Medicine, University of Toronto, Ontario, Canada
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Liu SY, Han LS, Guo JY, Zheng ZH, Li H, Zhang L, Zhang X, He YJ, Gao GM, Liu ZS, Zeng XF. Metabolic syndrome in Chinese patients with systemic lupus erythematosus: no association with plasma cortisol level. Lupus 2013; 22:519-26. [PMID: 23554041 DOI: 10.1177/0961203313478301] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Our objective was to determine metabolic syndrome (MS) prevalence in Chinese patients with systemic lupus erythematosus (SLE) and to investigate the conditions that contribute to its development. 116 patients with SLE classified according to the American College of Rheumatology (ACR) classification criteria, and 115 controls were enrolled. MS was defined by the joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity (IDF/NHLBI/AHA/WHF/IAS/IASO). SLE features and treatment of SLE were assessed. Fasting insulin and cortisol levels of 30 newly diagnosed, untreated patients and 33 age and sex-matched controls were detected. MS prevalence was 34.2% in patients with SLE and 14.8% in controls ( p = 0.002). Lupus patients with MS had less frequency of hydroxychloroquine (HCQ) intake (16.0% vs 45.8%; p = 0.012). Untreated patients with SLE had higher levels of fasting insulin (10.92 ± 13.53 vs 5.48 ± 5.43 uU/mL, p < 0.001) and plasma cortisol at 16:00 (257.22 ± 177.98 vs 139.84 ± 63.46 nmol/L, p = 0.001), but lower plasma cortisol at 08:00 (195.51 ± 149.84 vs 278.95 ± 136.27 nmol/L, p = 0.024). Comparisons regarding steroid therapy, levels of insulin and cortisol were not statistically significant between patients with MS and without MS. The Chinese patients with SLE presented a higher MS prevalence and fasting insulin than controls. MS was not associated with the steroid therapy and plasma cortisol. HCQ use proved to be protective against MS. The circadian rhythm of cortisol may differ in patients with SLE.
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Affiliation(s)
- S-Y Liu
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - L-S Han
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - J-Y Guo
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Z-H Zheng
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - H Li
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - L Zhang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - X Zhang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Y-J He
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - G-M Gao
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Z-S Liu
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - X-F Zeng
- Department of Rheumatology and Clinical Immunology, Peking Union Medical College Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
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Parker B, Urowitz MB, Gladman DD, Lunt M, Bae SC, Sanchez-Guerrero J, Romero-Diaz J, Gordon C, Wallace DJ, Clarke AE, Bernatsky S, Ginzler EM, Isenberg DA, Rahman A, Merrill JT, Alarcón GS, Fessler BJ, Fortin PR, Hanly JG, Petri M, Steinsson K, Dooley MA, Manzi S, Khamashta MA, Ramsey-Goldman R, Zoma AA, Sturfelt GK, Nived O, Aranow C, Mackay M, Ramos-Casals M, van Vollenhoven RF, Kalunian KC, Ruiz-Irastorza G, Lim S, Kamen DL, Peschken CA, Inanc M, Bruce IN. Clinical associations of the metabolic syndrome in systemic lupus erythematosus: data from an international inception cohort. Ann Rheum Dis 2012; 72:1308-14. [PMID: 22945501 PMCID: PMC3711497 DOI: 10.1136/annrheumdis-2012-202106] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The metabolic syndrome (MetS) may contribute to increased cardiovascular risk in systemic lupus erythematosus (SLE). We aimed to examine the association of demographic factors, lupus phenotype and therapy exposure with the presence of MetS. METHODS The Systemic Lupus International Collaborating Clinics Registry for Atherosclerosis inception cohort enrolled recently diagnosed (<15 months) SLE patients from 30 centres across 11 countries from 2000. Clinical, laboratory and therapeutic data were collected according to a standardised protocol. MetS was defined according to the 2009 consensus statement from the International Diabetes Federation. Univariate and backward stepwise multivariate logistic regression were used to assess the relationship of individual variables with MetS. RESULTS We studied 1686 patients, of whom 1494 (86.6%) had sufficient data to determine their MetS status. The mean (SD) age at enrolment and disease duration was 35.2 years (13.4) and 24.1 weeks (18.0), respectively. MetS was present at the enrolment visit in 239 (16%). In backward stepwise multivariable regression analysis, higher daily average prednisolone dose (mg) (OR 1.02, 95% CI 1.00 to 1.03), older age (years) (OR 1.04, 95% CI 1.03 to 1.06), Korean (OR 6.33, 95% CI 3.68 to 10.86) and Hispanic (OR 6.2, 95% CI 3.78 to 10.12) ethnicity, current renal disease (OR 1.79, 95% CI 1.14 to 2.80) and immunosuppressant use (OR 1.81, 95% CI 1.18 to 2.78) were associated with MetS. CONCLUSIONS Renal lupus, higher corticosteroid doses, Korean and Hispanic ethnicity are associated with MetS in SLE patients. Balancing disease control and minimising corticosteroid exposure should therefore be at the forefront of personalised treatment decisions in SLE patients.
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Affiliation(s)
- Ben Parker
- Arthritis Research UK Epidemiology Unit, Institute of Inflammation and Repair, Manchester Academic Health Sciences Centre, The University of Manchester, Manchester, UK
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de Miranda Moura dos Santos F, Borges MC, Telles RW, Correia MITD, Lanna CCD. Excess weight and associated risk factors in patients with systemic lupus erythematosus. Rheumatol Int 2012; 33:681-8. [DOI: 10.1007/s00296-012-2402-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2011] [Accepted: 03/11/2012] [Indexed: 11/28/2022]
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Lau CS, Cheung T. Should clinicians start measuring flow mediated dilation response in patients with systemic lupus erythematosus? J Rheumatol 2012; 38:1231-3. [PMID: 21724712 DOI: 10.3899/jrheum.110635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lee SG, Kim JM, Lee SH, Kim KH, Choi SA, Park EK, Jung WJ, Park YE, Park SH, Lee JW, Baek SH, Lee JH, Kim GT. Frequency of Metabolic Syndrome in Female Patients with Systemic Sclerosis: A Preliminary Report. JOURNAL OF RHEUMATIC DISEASES 2012. [DOI: 10.4078/jrd.2012.19.5.262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Seung-Geun Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Ji-Min Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sun-Hee Lee
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Kye-Hyung Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sang-A Choi
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Eun-Kyoung Park
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Woo-Jin Jung
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Young-Eun Park
- Department of Internal Medicine, Malgeunsem Hospital, Changwon, Korea
| | - Seong-Hu Park
- Department of Internal Medicine, Young-do Hospital, Busan, Korea
| | - Joung-Wook Lee
- Department of Internal Medicine, Busan St. Mary's Medical Center, Busan, Korea
| | - Seung-Hoon Baek
- Department of Internal Medicine, Ilsin Christian Hospital, Busan, Korea
| | - Jun-Hee Lee
- Department of Internal Medicine, Ilsin Christian Hospital, Busan, Korea
| | - Geun-Tae Kim
- Division of Rheumatology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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Abstract
Rheumatic diseases are associated with high cardiovascular morbidity and mortality. Considerable differences exist in the frequency of cardiovascular disease (CVD) risk factors and events among people of different ethnic origins, but little is known of the ethnic variations in the relative distribution of CVD risk factors and the degree of atherosclerosis in patients with rheumatic diseases. Understanding this variation will provide insight into the underlying pathogenesis of CVD in patients with rheumatic diseases, and aid in future studies of the detection and management of this complication. In general, although Asian patients seem to have fewer background CVD risk factors and are less affected by metabolic syndrome (MetS) than their non-Asian counterparts, those with rheumatic disease are equally as susceptible to CVD. Furthermore, it seems that systemic inflammation and mechanisms that do not involve conventional CVD risk factors and MetS have an important role in the development of atherosclerosis in patients with rheumatic diseases. Here we examine the frequency of conventional CVD risk factors and the prevalence of MetS in both Asian and non-Asian patients with selected rheumatic diseases. We also discuss the burden of CVD, as evaluated using various surrogate markers in these patients, and their overall CVD mortality rate.
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