Non-invasive assessment of endothelial dysfunction in pre-menopausal systemic lupus erythematosus women at risk of atherosclerosis

Abstract EN

Objective : to assess endothelial dysfunction in SLE patients through measuring endothelial reactivity in pre-menopausal female patients at risk of atherosclerosis without traditional cardiovascular risk factors.

Methodology : this study was conducted on 30 pre-menopausal SLE patients and 25 age and sex- matched volunteers.

All patients and controls were free of traditional cardiovascular risk factors.

We examined the endothelial function with brachial artery FMV, assessed with high resolution non-invasive ultrasound, where the diameter of the brachial artery was measured at rest and after reactive hyperemia.

Results : the FMV of the brachial artery (endothelium dependent response) was significantly lower in patients than in controls (4.1 ± 1.3 vs.

13.2 ± 2.0 % p < 0.001).

Comparing the FMV with the different variables of the patients’ group, we did not find any significant correlation between FMV and patients' age, disease duration, systolic and diastolic blood pressure, Raynaud's phenomenon, vacuities or ESR.

While, there was a highly significant difference in brachial artery FMV seen between 12 (40 %) aCL positive patients as compared to 18 (60 %) aCL negative patients ; and when compared with controls (4.0 ± 0.7 vs.

11.3 ± 0.6) %, p <0.001; 4.0 ±0.7 vs.

13.2 ±2.0 %, p<0.001 respectively).

There was also a strongly positive correlation between SLEDAI disease activity score and baseline diameter and FMV (rs = 0.42, p < 0.001 ; rs = 0.44, p < 0.001 respectively).

While there was a weakly positive statistical difference between FMV and the CRP (rs = -0.24, p = 0.05).

The baseline value of FMV showed an inverse correlation with LDL cholesterol (r = -0.41, p<0.05).

When we compared the patients who had received corticosteroids, antimalarial, methotrexate and / or other medications with those who had not, there was no significant statistical difference concerning FMV.

Conclusion : this study demonstrated that pre-menopausal SLE patients free from cardiovascular risk factors and overt CVD have an altered endothelial reactivity, which correlates positively with the aCL positive subgroup of patients, SLEDAI disease activity score, serum CRP values, along with high LDL cholesterol concentration.

This endothelial dysfunction indicates a higher susceptibility to the development of atherosclerotic disease.