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Published on: April 12, 2019
Peripheral vascular disease in systemic lupus patients
Rayford R June1, Lisabeth V Scalzi
1From the *Division of Rheumatology, Department of Medicine, University of Pittsburgh Medical Center, Pittsburgh; and †Division of Rheumatology, Departments of Medicine and Pediatrics, Pennsylvania State University/Milton S. Hershey Medical Center, Hershey, PA.
Insights
Systemic lupus erythematosus (SLE) patients have a higher prevalence of peripheral vascular disease (PVD), identified by ankle-brachial index (ABI). Smoking, not SLE itself, was the primary risk factor for PVD in this group.
Area of Science:
- Cardiology
- Rheumatology
- Vascular Medicine
Background:
- Systemic lupus erythematosus (SLE) is a known cardiovascular disease (CVD) risk factor.
- Ankle-brachial index (ABI) measures peripheral vascular disease (PVD) and correlates with CVD risk.
Purpose of the Study:
- To determine PVD prevalence in SLE patients.
- To identify PVD risk factors in SLE.
- To assess if SLE independently predicts PVD via ABI.
Main Methods:
- Cross-sectional study comparing SLE patients and controls without known CVD.
- Peripheral vascular disease (PVD) assessed using ankle-brachial index (ABI).
- Propensity score matching used to evaluate SLE as an independent PVD risk factor.
Main Results:
- Lower mean ABI (1.05 vs 1.09) and higher PVD prevalence (33% vs 20%) in SLE patients.
- Systemic lupus erythematosus (SLE) was not an independent risk factor for PVD.
- Smoking emerged as the sole significant risk factor for PVD in SLE patients.
Conclusions:
- Ankle-brachial index (ABI) is a practical tool for PVD screening in SLE.
- A 33% PVD prevalence was observed in SLE, strongly linked to smoking.
- Screening ABI in SLE patients, especially smokers, can aid cardiovascular risk assessment and management.
Background:
Systemic lupus erythematosus (SLE) is an independent risk factor for cardiovascular disease (CVD). Ankle-brachial index (ABI) is a measure of peripheral vascular disease (PVD), low values of which are associated with CVD.
Objectives:
Objectives were to identify the prevalence of PVD in SLE, to identify risk factors associated with PVD in SLE, and to determine whether SLE is an independent risk factor for PVD as assessed by ABI.
Methods:
In a cross-sectional analysis of SLE subjects and control subjects, free of known CVD, SLE-related variables and cardiovascular risk factors were measured. Peripheral vascular disease was assessed using ABI. The prevalence of PVD (ABI ≤ 1.0) and comparisons of mean ABI, between SLE and control subjects, were examined. Systemic lupus erythematosus was examined as an independent risk for PVD in the cohort using propensity score matching. Logistic regression was performed to identify independent risk factors for PVD in SLE.
Results:
Ankle-brachial index was lower in the 134 SLE subjects compared with 77 control subjects: 1.05 versus 1.09 (P = 0.003), and the prevalence of PVD was higher in SLE than in control subjects (33% vs 20%; P = 0.037). Systemic lupus erythematosus was not an independent risk for PVD. In the SLE subjects, the only significant risk factor for PVD was smoking.
Conclusions:
Ankle-brachial index, a marker of subclinical CVD, is an inexpensive and easy method in which to assess PVD. There was a 33% prevalence of PVD in SLE, which was independently associated with smoking. As PVD is a coronary artery disease risk equivalent, screening and diagnosis may change lipid management in preventive cardiovascular risk assessment in patients with SLE. The combination of SLE and a smoking history may identify individuals for whom checking an ABI makes particular sense.
