Lack of subclinical myocardial ischaemia in Mexican patients with systemic lupus erythematosus without traditional risk factors for coronary artery disease

Abstract

The objective of this study was to analyse whether patients with systemic lupus erythematosus (SLE) without traditional risk factors for coronary artery disease (CAD) develop subclinical myocardial ischaemia in the first years after diagnosis. A cross-sectional analysis of a cohort of 200 female SLE patients was conducted. We selected those patients who fulfilled the American College of Rheumatology (ACR) SLE criteria and had no traditional risk factors for CAD, including diabetes mellitus, hypertension, obesity, hyperlipidemia, and smoking. After an initial clinical and laboratory examination, patients were evaluated using a baseline echocardiogram and a dobutamine and atropine stress echocardiogram to search for subclinical myocardial ischaemia. Forty-one patients were included in the study. The mean age at the time of the study was 34.5 ± 9.56 years (mean ± SD). The mean age at diagnosis was 30.3 ± 9.39 years. The mean time from diagnosis was 3.9 ± 3.3 years. Baseline disease activity index (MEX-SLEDAI score) showed that 92.6% of patients had disease activity, although most patients had mild activity. A dobutamine and atropine stress echocardiogram was performed in 40 patients. All 40 patients had negative tests for subclinical myocardial ischaemia. Patients without traditional risk factors for CAD do not have an increased risk for subclinical myocardial ischaemia in the first years after diagnosis. A longitudinal follow-up study of these patients is needed to confirm our findings and assess if additional non-traditional risk factors for CAD increase the risk for myocardial ischaemia. Lupus (2007) 16, 298—301.

Keywords

atherosclerosis stress echocardiogram subclinical coronary artery disease systemic lupus erythematosus

Get full access to this article

View all access options for this article.

References

Croker JA , Kimberly RP SLE: challenges and candidates in human disease. Trends Immunol 2005; 26: 580—586.

Rhew EY , Ramsey-Goldman R. Premature atherosclerotic disease in systemic lupus erythematosus — role of inflammatory mechanisms. Autoimmun Rev 2006; 5: 101—105.

Doria A. , Iaccarino L. , Sarzi-Puttini P. , Atzeni F. , Turriel M. , Petri M. Cardiac involvement in systemic lupus erythematosus. Lupus 2005; 14: 683—686.

Petri M. , Perez-Gutthann S. , Spence D. , Hochberg MC Risk factors for coronary artery disease in patients with systemic lupus erythematosus . Am J Med 1992; 93: 513—519.

Manzi S. , Meilahn EN , Rairie JE et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol 1997; 145: 408—415.

Cervera R. , Khamashta MA , Font J. et al. Morbidity and mortality in systemic lupus erythematosus during a 5-year period: a multicenter prospective study of 1000 patients. European Working Party on Systemic Lupus Erythematosus. Medicine 1999; 78: 167—175.

Jonsson H. , Nived O. , Surfelt G. Outcome in systemic lupus erythematosus: a prospective study of patients from a defined population. Medicine 1989; 68: 141—150.

Jara LJ , Medina G. , Vera-Lastra O. , Amigo MC Accelerated atherosclerosis, immune response and autoimmune rheumatic diseases . Autoimmun Rev 2006; 5: 195—201.

Petri M. , Spence D. , Bone LR , Hochberg MC Coronary artery disease risk factors in the Johns Hopkins lupus cohort: prevalence, recognition by patients and preventive practice. Medicine 1992; 71: 291—302.

10.

Tan EM , Cohen AS , Fries JF et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum 1982; 25: 1271—1277.

11.

Guzman J. , Cardiel MH , Arce-Salinas A. et al. Measurement of disease activity in systemic lupus erythematosus. Prospective validation of 3 clinical indices. J Rheumatol 1992; 19: 1551—1558.

12.

Rahaman P. , Gladman DD , Urowitz MB Premature coronary artery disease in systemic lupus erythematosus in the absence of corticosteroid use. J Rheumatol 2000; 27: 1323—1325.

13.

Petri M. , Roubenoff R. , Dallal GE et al. Plasma homocysteine as a risk factor for atherothrombotic events in systemic lupus erythematosus. Lancet 1996 ; 348: 1120—1124.

14.

Doria A. , Shoenfeld Y. , Wu R. et al. Risk factors for subclinical al atherosclerosis in a prospective cohort of patients with systemic lupus erythematosus. Ann Rheum Dis 2003; 62: 1071—1077.

15.

Petri M. Hopkins Lupus Cohort. 1999 update. Rheum Dis Clin North Am 2000; 26: 199—213.

16.

Svenungsson E. , Jensen-Urstad K. , Heimburger M. et al. Risk factors for cardiovascular disease in systemic lupus erythematosus. Circulation 2001; 104: 1887—1893.

17.

Svenungsson E. , Gunnarsson I. , Fei GZ , Lundberg IE , Klareskog L. , Frostegard J. Elevated triglycerides and low HDL as markers of disease activity and closely related to an upregulation of the TNF-α/TNFR system in systemic lupus erythematosus. Arthritis Rheum 2003; 48: 2533—2540.

18.

Svenungsson E. , Fei GZ , Jensen-Urstad K. , de Faire U. , Hamsten A. , Frostegard J. TNF-alpha: a link between hypertriglyceridaemia and inflammation in SLE patients with cardiovascular disease. Lupus 2003; 12: 454—461.

19.

Sun SS , Shiau YC , Tsai SC , Lin CC , Kao A. , Lee CC The role of technetium-99 m sestamibi myocardial perfusion single-photon emission computed tomography (SPECT) in the detection of cardiovascular involvement in systemic lupus erythematosus patients with non-specific chest complaints . Rheumatology (Oxford) 2001; 40: 1106—1111.