Endothelial function and markers of endothelial activation in relation to cardiovascular disease in systemic lupus erythematosus

• Published in: Scandinavian journal of rheumatology Vol. 37; no. 5; pp. 352 - 359
• Main Authors: Svenungsson, E., Cederholm, A., Jensen-Urstad, K., Fei, G.-Z., de Faire, U., Frostegård, J.
• Format: Journal Article
• Language: English
• Published: Colchester Informa UK Ltd 01.01.2008; Taylor & Francis
• Subjects: Adult; Biological and medical sciences; Biomarkers - blood; Blood Flow Velocity - physiology; Brachial Artery - diagnostic imaging; Brachial Artery - physiopathology; Cardiovascular Diseases - blood; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - physiopathology; Case-Control Studies; Diseases of the osteoarticular system; Endothelium, Vascular - physiopathology; Female; Humans; Lupus Erythematosus, Systemic - blood; Lupus Erythematosus, Systemic - physiopathology; Medical sciences; Medicin och hälsovetenskap; Middle Aged; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; Thrombomodulin - blood; Tumor Necrosis Factor-alpha - blood; Ultrasonography; Vascular Cell Adhesion Molecule-1 - blood; Immunopathology; Connective tissue disease; Skin disease; Systemic lupus erythematosus; Systemic disease; Rheumatology; Autoimmune disease; Cardiovascular disease; Activation
• ISSN: 0300-9742; 1502-7732; 1502-7732
• DOI: 10.1080/03009740802007514

Objective: Cardiovascular disease (CVD) is common in patients with systemic lupus erythematosus (SLE) although it is not clear whether an increased risk of CVD is a general feature of SLE or whether it applies only to a subgroup of patients. Our objective was to evaluate endothelial function and markers of endothelial activation in relation to CVD in SLE. Methods: Twenty-six women with SLE and previous CVD (SLE CVD cases, defined as objectively verified angina pectoris, myocardial infarction, cerebral infarction, or intermittent claudication; 52±8.2 years) were compared with age-matched SLE women without CVD (SLE controls) and population control women. Flow-mediated dilatation (FMD) of the brachial artery after reactive hyperaemia and nitroglycerin-mediated dilatation (NMD) after sublingual nitroglycerin administration were determined by ultrasound. Soluble thrombomodulin (sTM) and soluble vascular cellular adhesion molecule-1 (sVCAM-1) were measured by enzyme-linked immunosorbent assay (ELISA). Results: FMD and NMD levels did not differ between SLE controls and population controls. In SLE cases FMD and NMD were not assessed because of interference with nitro-related medication. sVCAM-1 discriminated between SLE cases, SLE controls, and population controls (ng mL; 814±221 vs. 545±214 vs. 401±189, p<0.01), whereas sTM (ng mL; 5.2±2.8 vs. 4.2±1.9 vs. 3.0±0.5) differed between both SLE groups and controls (p<0.05). Conclusion: In this study SLE women free of CVD had good endothelial function (FMD), a possible marker of protection from lupus-related CVD. In addition, high levels of sVCAM-1, associated with systemic tumour necrosis factor-alpha (TNF ) activity, were identified as a novel discriminator for SLE-related CVD. This supports our hypothesis that SLE patients with enhanced systemic TNF activity are at high risk of developing CVD.