Cardiovascular risk profile in systemic lupus erythematosus and rheumatoid arthritis: a comparative study of female
Maria José Santos1, Filipe Vinagre, José José Silva
1Rheumatology Research Unit, Instituto de Medicina Molecular da Faculdade de Medicina da Universidade de Lisboa, Edifício Egas Moniz, Lisbon, Portugal. mjps@netvisao.pt
Insights
Cardiovascular risk factors differ between women with Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA). Lupus patients show a more atherogenic lipid profile, while RA patients exhibit higher insulin resistance, impacting cardiovascular disease risk.
Area of Science:
- Rheumatology
- Cardiology
- Endocrinology
Background:
- Premature atherosclerosis and high cardiovascular (CV) risk are documented in Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA).
- Conventional CV risk factors do not fully explain the elevated risk in these inflammatory diseases but remain significant contributors to atherosclerosis.
Purpose of the Study:
- To investigate the differential associations of CV risk factors in women with SLE and RA.
- To compare the prevalence and impact of traditional CV risk factors between SLE and RA patients.
Main Methods:
- Assessment of 100 women with SLE, 98 with RA, and 102 controls for Framingham CV risk factors (hypertension, hypercholesterolemia, low HDL, diabetes, smoking).
- Evaluation of other CV risks including atherogenic index of plasma (AIP), insulin resistance, obesity, metabolic syndrome, uric acid, sedentarism, and family history.
Main Results:
- Modifiable CV risk factors were more prevalent in SLE and RA than in controls.
- Hypertension was more common in young SLE patients, hypercholesterolemia in RA, and low HDL-C in SLE.
- SLE women had a more atherogenic lipid profile (lower HDL-C, higher cholesterol/HDL-C and AIP) and higher uric acid levels than RA patients.
- Insulin resistance was significantly higher in RA patients compared to SLE patients, even after adjustments.
Conclusions:
- The cardiovascular risk profile is distinct in women with SLE and RA.
- The contribution of traditional CV risk factors to atherogenesis may differ between SLE and RA.
- Prospective studies are needed to determine how managing modifiable risks can improve CV outcomes in these inflammatory conditions.
Objective:
Premature atherosclerosis is well-documented both in Systemic Lupus Erythematosus (SLE) and in Rheumatoid Arthritis (RA) patients, but cardiovascular (CV) risk is particularly high in lupus women. Although conventional CV risk factors do not fully explain the excessive risk in inflammatory diseases, they remain major contributors to atherosclerosis. The aim of the present study was to investigate whether CV risk factors are differentially associated with SLE and RA.
Methods:
One hundred women with SLE, 98 with RA and 102 controls matched on age and without overt CV or renal disease were assessed for the presence of Framingham (hypertension, hypercholesterolemia, low HDL, diabetes, smoking) and other CV risks (atherogenic index of plasma (AIP), insulin resistance, obesity, central obesity, metabolic syndrome, uric acid, sedentarism, hypothyroidism and family history of premature CV disease).
Results:
Modifiable CV risk factors are highly prevalent and occur more frequently in SLE and RA than in age-matched controls. Some differences in Framingham risk factors were found between SLE and RA, with hypertension being more common in young lupus women, hypercholesterolemia more frequent in RA and low HDL-C more frequent in SLE. However, the estimated 10-year Framingham CHD risk or the Reynolds Risk Score was comparable in both diseases. Although hypercholesterolemia was more frequent in RA, lupus women display a more atherogenic lipid profile, with significantly lower HDL-C levels (56.5±16 mg/dl versus 63.7±18; p=0.005), and more cases above the high risk cutpoints for cholesterol/HDL-C (14% versus 4.1%; p=0.01) and for AIP (15% versus 6.1%; p=0.03). Also, uric acid levels are higher in SLE women (4.8±1.5 mg/dl) than in RA (4.1±1.1 mg/dl), p=0.001. On the other hand, insulin resistance is significantly higher in women with RA as compared with SLE (median HOMA-IR 3.5 [6.4]) versus 0.72 [2.5]; p<0.0001) and the difference remained significant after adjustment for BMI and corticosteroids.
Conclusions:
Cardiovascular risk profile is distinct in SLE and RA women and the contribution of traditional CV risk factors to atherogenesis may be different in these two diseases. Prospective studies are necessary to understand how the control of modifiable risks can improve CV outcome in different inflammatory settings.
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