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Vascular stiffness in women with systemic lupus erythematosus
F Selzer1, K Sutton-Tyrrell, S Fitzgerald
1University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
Insights
Systemic lupus erythematosus (SLE) is linked to arterial stiffness, particularly in premenopausal women. SLE-specific factors like inflammation and active disease contribute to central artery stiffening, explaining higher cardiovascular risks.
Area of Science:
- Cardiovascular research
- Rheumatology
- Immunology
Background:
- Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease.
- SLE patients exhibit increased rates of hypertension and cardiovascular disease.
- Reduced central artery elasticity may precede major vascular disease in SLE.
Purpose of the Study:
- To evaluate risk factors for aortic stiffness, measured by pulse wave velocity (PWV), in women with SLE.
- To determine if SLE-specific factors, particularly inflammation and disease activity, correlate with increased PWV.
- To analyze differences in risk factors between premenopausal and postmenopausal women with SLE.
Main Methods:
- A study involving 220 women with SLE at the Pittsburgh Lupus cohort.
- Risk factor data collected concurrently with ultrasound examinations.
- Pulse wave velocity (PWV) measured using Doppler probes from carotid and femoral arteries.
Main Results:
- Among postmenopausal women, traditional risk factors (age, blood pressure, obesity) were associated with PWV.
- In premenopausal women, PWV was linked to SLE-specific factors (C3 levels, ds-DNA antibodies, hydroxychloroquine use) and traditional factors.
- SLE-specific variables were associated with increased aortic PWV, especially in premenopausal women.
Conclusions:
- Aortic stiffness in SLE is influenced by both traditional and SLE-specific risk factors.
- Premenopausal women with SLE show a stronger association between SLE activity and arterial stiffening.
- Findings may elucidate the elevated cardiovascular disease and hypertension rates in younger women with SLE.
Abstract:
Large-vessel manifestations of systemic lupus erythematosus (SLE), a multisystem disease characterized by disturbances in the immune system, include higher than expected rates of hypertension and cardiovascular disease. Reductions in the elasticity of central arteries may act as a marker of early changes that predispose to the development of major vascular disease. This study evaluated risk factors associated with aortic stiffness measured by pulse wave velocity (PWV) in women with SLE. We expected SLE-specific factors, especially variables indicative of inflammation and active disease, to be associated with increasing PWV. The study population included 220 women currently enrolled in the Pittsburgh Lupus
Registry:
All risk factor data were collected on the day of the ultrasound examinations. PWV waveforms were collected from the right carotid and femoral arteries by Doppler probes. The mean age of the women was 45.5+/-10.8 years, the median SLE disease duration approximated 9 years, and the mean PWV was 6.1+/-1.7 m/s. Multiple regression models were stratified by menopausal status. Among postmenopausal women, PWV risk factors were primarily traditional factors and included age, systolic blood pressure, family history of vascular disease, carotid plaque, creatinine, obesity, glucose, white cell count, and cumulative SLE organ damage. Among premenopausal women, PWV risk factors consisted of a mix of SLE-related and traditional variables and included higher C3 levels, presence of ds-DNA antibodies, nonuse of hydroxychloroquine, lower leukocyte count, higher mean arterial pressure, and carotid plaque. SLE-specific variables appeared to be associated with increases in aortic PWV, indicating central artery stiffening. This was seen most clearly among premenopausal women. This finding may partially explain the higher rates of cardiovascular disease and hypertension observed in young women with SLE.