Factors associated with the appearance of subclinical atherosclerosis in systemic lupus erythematosus

Authors

  • Yanileydys Hernández Muñiz Universidad de Ciencias Médicas de La Habana. Centro de Referencia para las Enfermedades Reumáticas. Hospital Docente Clínico Quirúrgico 10 de Octubre. Facultad de Ciencias Médicas 10 de Octubre. La Habana https://orcid.org/0000-0001-5553-3371
  • Diosmary Dedieu Montero Universidad de Ciencias Médicas de La Habana. La Habana https://orcid.org/0000-0002-1429-2791
  • Silvia María Pozo Abreu Universidad de Ciencias Médicas de La Habana. Hospital Docente Clínico Quirúrgico 10 de Octubre. Facultad de Ciencias Médicas 10 de Octubre https://orcid.org/0000-0001-7125-3572
  • Carlos Carrillo Reyes Universidad de Ciencias Médicas de La Habana. Centro de Referencia para las Enfermedades Reumáticas. Hospital Docente Clínico Quirúrgico 10 de Octubre. Facultad de Ciencias Médicas 10 de Octubre. La Habana https://orcid.org/0000-0003-4726-1948
  • Ailyn Mederos Castellanos Universidad de Ciencias Médicas de La Habana. Centro de Referencia para las Enfermedades Reumáticas. Hospital Docente Clínico Quirúrgico 10 de Octubre. Facultad de Ciencias Médicas 10 de Octubre. La Habana https://orcid.org/0000-0002-0531-0476

Keywords:

subclinical atherosclerosis, systemic lupus erythematosus, risk factor

Abstract

Introduction: Systemic lupus erythematosus is an inflammatory, chronic, multisystemic disease, which is defined by its multiple clinical features and by the almost invariable presence of autoantibodies directed against one or more components of the cell nucleus.

Objective: To characterize patients with Systemic Lupus Erythematosus and to identify its possible relationship with subclinical atherosclerosis.

Methods: A descriptive cross-sectional study of patients diagnosed with Systemic Lupus Erythematosus, treated at the Rheumatology Center in Havana, was carried out during the period from October 2015 to October 2017. The sample was non-probabilistic and consisted of 50 patients. Descriptive and inferential statistics were used.

Results: Of the total number of patients, 54.0% (n=27) had subclinical atherosclerosis. The traditional risk factors that showed association with the presence of plaque in patients with SLE were hypercholesterolemia, 70.4% (n=19) and hypertriglyceridemia 55.6% (n=15). A relationship was observed between the time of evolution, the presence of accumulated damage, renal compromise, CRP figures and accumulated dose of steroids, with the presence of subclinical atherosclerosis.

Conclusions: A higher average age was found in patients with SLE and presence of plaque. The traditional risk factors that showed association with the presence of atherosclerotic plaque were hypercholesterolemia and hypertriglyceridemia. An association was found between the time of evolution, the presence of accumulated damage, renal compromise, CRP figures and the accumulated dose of steroids, with the presence of plaque. In the study patients, the use of chloroquine was associated with the absence of subclinical atherosclerosis.

Downloads

Download data is not yet available.

Author Biographies

Yanileydys Hernández Muñiz, Universidad de Ciencias Médicas de La Habana. Centro de Referencia para las Enfermedades Reumáticas. Hospital Docente Clínico Quirúrgico 10 de Octubre. Facultad de Ciencias Médicas 10 de Octubre. La Habana

Especialista de primer grado en Medicina General Integral y Reumatología.

Profesora asistente

Diosmary Dedieu Montero, Universidad de Ciencias Médicas de La Habana. La Habana

Especialista de primer grado en Reumatología

Silvia María Pozo Abreu, Universidad de Ciencias Médicas de La Habana. Hospital Docente Clínico Quirúrgico 10 de Octubre. Facultad de Ciencias Médicas 10 de Octubre

Especialista de primer grado en Bioestadística y de segundo grado en Medicina General Integral.

Profesora asistente

Carlos Carrillo Reyes, Universidad de Ciencias Médicas de La Habana. Centro de Referencia para las Enfermedades Reumáticas. Hospital Docente Clínico Quirúrgico 10 de Octubre. Facultad de Ciencias Médicas 10 de Octubre. La Habana

Especialista de primer grado en Medicina General Integral y Reumatología.

Profesor instructor

Ailyn Mederos Castellanos, Universidad de Ciencias Médicas de La Habana. Centro de Referencia para las Enfermedades Reumáticas. Hospital Docente Clínico Quirúrgico 10 de Octubre. Facultad de Ciencias Médicas 10 de Octubre. La Habana

Especialista 1er Grado en Medicina General Integral y Reumatología

References

Battagliotti CA, Kilstein J, Gentiletti AA, Pons Estel B. Lupus Eritematoso Sistémico. Aspectos clínicos y terapéuticos. 2da. ed. Buenos Aires: Ed: CB Eitores; 1998. p. 187-94.

Petri M. La cohorte de Lupus de Hopkins. Puesta al día. Clínic Rheumatic Disease of North America (Edición Española). 2000;(2):203-17.

Font J. Khamashta M, Vilardell M. Lupus Eritematoso Sistémico. Segunda parte, Capítulo VI. Barcelona: Ed. MRA, S.L; 1996. p. 73-239.

Hetjmancik MR, Wright IJC, Quint R, Jennings, FL. The cardiovascular manifestations of systemic lupus erythematosus. Am Heart J. 1964;68(1):119-30.

Rahman P, Urowitz MB, Gladman DD, Bruce IN, Genest J. Contribution of tradicional risk factors to coronary artery disease in patients with systemic lupus erythematosus. J Rheumatol [Internet]. 1999 [citado 15 May 2017];26(11):2363-8. Disponible en: https://pubmed.ncbi.nlm.nih.gov/10555892/

Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation [Internet] 2005 [citado 15 May 2017];112(17):2735-52. Disponible en: https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.105.169404

Cistermas M. Ateroesclerosis en Enfermedades Reumatológicas. ¿Mito o Realidad?. Reumatología [Internet]. 2006 [citado 15 May 2017];22(1):9-13. Disponible en: https://pesquisa.bvsalud.org/portal/resource/pt/lil-452444

Esdaile JM, Abrahamowicz M, Grodzicky T, Li Y, Panaritis C, du Berger R, et al. Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum [Internet]. 2001 [citado 3 May 2017]; 2001(10):2331-7. Disponible en: https://pubmed.ncbi.nlm.nih.gov/11665973/

Liang MH, Socher SA, Roberts WN, Esdaile JM. Measurements of systemic lupus erythematosus activity in clinical research. Arthritis Rheum [Internet]. 1988 [citado 3 May 2017];31(7):817-25. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1002/art.1780310701

Hernández Muñiz Y, Guibert Toledano ZM, Reyes Llerena GA. Correlación de las cifras de proteína C reactiva y aterosclerosis en pacientes con lupus eritematoso sistémico. Rev Cuba Reumatol [Internet]. 2015 Ago [citado 3 May 2017];17(2):[aprox. 5 p.]. Disponible en: http://www.revreumatologia.sld.cu/index.php/reumatologia/article/view/414/pdf_18

Tan EM, Cohen AS, Fries JF, Masi AT, Mcshane DJ, Rothfield NF, et al. The 1982 revised criteria for the classification of systemic lupus erythematosus. Arthritis Rheum [Internet]. 1982 [citado 3 May 2017];25(11):1271-7. Disponible en: https://onlinelibrary.wiley.com/doi/abs/10.1002/art.1780251101

Doria A, Shoenfield Y, Wu R, Gambari PF, Puato M, Ghirardello A, et al. Risk factors for subclinical atherosclerosis in a prospective cohort of patients with systemic lupus erythematosus. Ann Rheum Dis [Internet]. 2003 [citado 3 May 2017];62(11):1071-7. Disponible en: https://pubmed.ncbi.nlm.nih.gov/14583570/

Manzi S, Meilahn EN, Rairie JE, Conte CG, Medsger TA, Jansen-McWilliams, et al. Age-specific Incidente Rates of Myocardial Infarction and Angina in Women with Systemic Lupus Erythematosus: Comparison with the Framingham Study. Am J Epidemiol [Internet]. 1997 [citado 3 May 2018];145(5):408-15. Disponible en: https://academic.oup.com/aje/article-abstract/145/5/408/120887

Petri M, Roubenoff R, Dallal GE, Nadeau MR, Selhub J, Rosenberg I. Plasma homocysteine as a risk factor for atherothrombotic events in systemic lupus erythematosus. Lancet [Internet]. 1996 [citado 3 May 2018];348(9035):1120-4. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0140673696030322

Abu-Shakra M, Urowitz MB, Gladman DD, Gough J. Mortality studies in systemic lupus erythematosus. Results from a single center. I. Causes of death. J Rheumatol [Internet]. 1995 [citado 3 May 2018];22(7):1259-64.Disponible en: https://europepmc.org/article/med/7562755

Guibert Toledano ZM, Reyes Llerena GA, Hernández Muñiz Y, Ugarte Moreno D, Miñoso Arafi Y. Morbilidad cardiovascular y evaluación de aterosclerosis en pacientes con lupus eritematoso sistémico. Rev Cuba Reumatol [Internet]. 2016 Ago [citado 3 May 2018];18(2):[aprox. 7 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1817-59962016000200002&lng=es

Estévez del Toro M, Chico Capote A, Barahona Jorge RA, Jiménez Paneque R, Hernández Castro J. Prevalencia de enfermedad vascular aterosclerótica en pacientes cubanos con lupus eritematoso sistémico. Reumatol Clin [Internet]. 2008 [citado 3 May 2018];4(1):13-8. Disponible en: https://www.sciencedirect.com/science/article/pii/S1699258X0871790X

Duarte C, Couto M, Vaz C, Ines L, Malcata A. Perfil de risco cardiovascular numa população portuguesa de doentes com LES. Acta Reumatol Port [Internet]. 2009 [citado 3 May 2018];34(2):349-57. Disponible en: http://hdl.handle.net/10400.4/630

Rodríguez Hernández R, Alberteris Rodríguez A, López Báster J, Diéguez Martínez M, Miguel-Soca PE, Cutié Anido Y. Factores de riesgo asociados a hipertensión arterial en pacientes con lupus eritematoso sistémico. Holguín, Cuba. Rev Haban Cienc Méd [Internet]. 2017 Dic [citado 3 May 2018];16(6):[aprox. 4 p.]. Disponible en: http://scielo.sld.cu/scielo.php?script=sci_arttext&pid=S1729-519X2017000600011&lng=es

Lahoz C, Mostaza JM. La aterosclerosis como enfermedad sistémica. Rev Esp Cardiol [Internet]. 2007 [citado 3 May 2018];60(2):184-95. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/S0300893207750091

Stamler J, Wentworth D, Neaton JD. Is relationship between serum cholesterol and risk of premature death from coronary heart disease continuous and graded? Findings in 356,222 primary screenees of the Multiple Risk Factor Intervention Trial (MRFIT). JAMA [Internet]. 1986 [citado 3 May 2018];256:2823-8. Disponible en: https://jamanetwork.com/journals/jama/article-abstract/363231

Kannel WB, Castelli WP, Gordon T, McNamara PM. Serum cholesterol, lipoproteins, and the risk of coronary heart disease. The Framingham study. Ann Intern Med. 1971 [citado 3 May 2018];74:1-12. Disponible en: https://www.acpjournals.org/doi/abs/10.7326/0003-4819-74-1-1

Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet [Internet]. 2005 [citado 3 May 2018];366:1267-78. Disponible en: https://www.thelancet.com/journals/lancet/article/PIIS0140673605673941/fulltext

Cacciapaglia F, Zardi EM, Coppoloni G, Buzzulini F, Margiotta D, Arcarece L, et al. Stiffness parameters, intima-media thickness and early aterosclerosis in systemic lupus erythematosus patients. Lupus [Internet]. 2009 [citado 3 May 2018];18(3):249-56. Disponible en: https://journals.sagepub.com/doi/abs/10.1177/0961203308097571

Urowitz MB, Bookman AA, Koehler BE, Gordon DA, Smytheet HA, Ogryzlo MA. The bimodal mortality pattern of systemic lupus erythematosus. Am J Med [Internet]. 1976 [citado 3 May 2018];60(2):221-5. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/0002934376904319

Rubin LA, Urowitz MB, Gladman DD. Mortality in systemic lupus erythematosus: the bimodal mortality pattern revisited. QJM [Internet]. 1985 [citado 3 May 2018];55(1):87-98. Disponible en: https://academic.oup.com/qjmed/article-abstract/55/1/87/1512652

Bruce IN, Urowitz MB, Gladman DD, Ibañez D, Steiner G. Risk factors for coronary heart disease in women with systemic lupus erythematosus: The Toronto Risk Factor Study. Arthritis Rheum [Internet]. 2003 [citado 3 May 2018];48(11):3159-67. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1002/art.11296

Silvariño R, Inoue Sato E. Factores de riesgo para aterosclerosis en enfermedades autoinmunitarias sistémicas. Rev Med Urug [Internet]. 2008 [citado 3 May 2018];24(2):118-32. Disponible en: http://www.scielo.edu.uy/scielo.php?script=sci_arttext&pid=S1688-03902008000200007

Johansson E, Forsberg K, Johnsson H. Clinical and experimental evaluation of the thromboprophylactic effect of hydroxychloroquine sulfate after total hip replacement. Haemostasis [Internet]. 1981 [citado 3 May 2018];10(2):89-96. Disponible en: https://www.karger.com/Article/Abstract/214391

Prowse C, Pepper D, Dawes J. Prevention of the platelet alphagranule release reaction by membrane-active drugs. Thromb Res [Internet]. 1982 [citado 3 May 2018]; 25(3):219-27. Disponible en: https://www.sciencedirect.com/science/article/abs/pii/0049384882902419

van Halm VP, Nurmohamed MT, Twisk JW, Dijkmans BA, Voskuyl AE. Disease modifying antirheumatic drugs are associated with a reduced risk for cardiovascular disease in patients with rheumatoid arthritis: a case control study. Arthritis Res Ther [Internet]. 2006 [citado 3 May 2018];8(5):[aprox. 10 p.]. Disponible en: https://arthritis-research.biomedcentral.com/articles/10.1186/ar2045

del Rincón I, O’Leary DH, Haas RW, Escalante A. Effect of glucocorticoids on the arteries in rheumatoid arthritis. Arthritis Rheum [Internet]. 2004 [citado 3 May 2018];50(12):[aprox. 15 p.]. Disponible en: https://onlinelibrary.wiley.com/doi/full/10.1002/art.20661

Solomon DH, Karlson EW, Rimm EB, Cannuscio CC, Mandl LA, Manson JE, et al. Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation [Internet]. 2003 [citado 3 May 2018];107(9):1303-7. Disponible en: https://www.ahajournals.org/doi/abs/10.1161/01.CIR.0000054612.26458.B2

Gladman DD, Urowitz MB. Morbidity in systemic lupus erythematosus. J Rheumatol [Internet]. 1987 [citado 3 May 2018];14(Suppl.13):223-6. Disponible en: https://pubmed.ncbi.nlm.nih.gov/3612650/

Published

2022-01-27

How to Cite

1.
Hernández Muñiz Y, Dedieu Montero D, Pozo Abreu SM, Carrillo Reyes C, Mederos Castellanos A. Factors associated with the appearance of subclinical atherosclerosis in systemic lupus erythematosus. Rev. cuba. de Reumatol. [Internet]. 2022 Jan. 27 [cited 2025 Mar. 12];24(1):e265. Available from: https://revreumatologia.sld.cu/index.php/reumatologia/article/view/989

Issue

Section

Original research article