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Lupus: Atherosclerosis Risk Factor

Be vigilant about atherosclerosis in lupus patients.

Two case-control studies have confirmed a previously suggested link between systemic lupus erythematosus and atherosclerosis.

In one study, 197 patients with lupus in a single-center autoimmune-disease registry were matched by age, sex, race, and hypertension status with a separate group of 197 controls without lupus. Mean blood pressure was significantly higher among controls (119/74 mm Hg) than among lupus patients (110/71 mm Hg), but other characteristics and risk factors (including hypertension) were similar in the two groups.

According to carotid ultrasonography, atherosclerotic plaques (i.e., focal protrusion >50%) were significantly more prevalent in lupus patients than in controls (37% vs. 15%), especially among people age 40 or younger (13% vs. 2%). Compared with lupus patients without atherosclerotic plaque, lupus patients with plaque had a significantly greater length of disease and extent of disease-related damage, a significantly lower rate of cyclophosphamide use, and a nonsignificantly higher mean C-reactive protein level.

In a separate study, 65 lupus patients were matched with 69 controls without lupus. Compared with controls, lupus patients had significantly higher mean homocysteine and triglyceride levels and were more likely to smoke and to have hypertension.

According to electron-beam computed tomography, significantly more lupus patients (31%) than controls (9%) had coronary-artery calcification (mean scores: 68.9 vs. 8.8, respectively). Among patients with calcification, 15% of lupus patients versus 4% of controls had scores at or above the median (64). Within the lupus group, C-reactive protein levels did not vary with calcification status.

Comment: These two studies document a link between lupus and increased risk for atherosclerosis. Although the underlying reason for this association is not yet clear, the findings should prompt clinicians to be vigilant about atherosclerosis in lupus patients and to modify cardiovascular risk factors when appropriate.

— Harlan M. Krumholz, MD, SM

Published in Journal Watch Cardiology March 5, 2004

Citation(s):

Roman MJ et al. Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. N Engl J Med 2003 Dec 18; 349:2399-406.

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• Medline abstract (Free)

Asanuma Y et al. Premature coronary-artery atherosclerosis in systemic lupus erythematosus. N Engl J Med 2003 Dec 18; 349:2407-15.

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• Medline abstract (Free)

Hahn BH. Systemic lupus erythematosus and accelerated atherosclerosis. N Engl J Med 2003 Dec 18; 349:2379-80.

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• Medline abstract (Free)