Frequency of established cardiovascular disease and its risk factors in Chinese patients with systemic lupus erythematosus

Cardiovascular events (CVEs) are prevalent in patients with systemic lupus erythematosus (SLE), and it is the young women who are disproportionately at risk. The risk factors for accelerated cardiovascular disease remain unclear, with multiple studies producing conflicting results. In this paper, we aim to address both traditional and SLE-specific risk factors postulated to drive the accelerated vascular disease in this cohort. We also discuss the more recent hypothesis that adverse pregnancy outcomes in the form of maternal–placental syndrome and resultant preterm delivery could potentially contribute to the CVEs seen in young women with SLE who have fewer traditional cardiovascular risk factors. The pathophysiology of how placental-mediated vascular insufficiency and hypoxia (with the secretion of placenta-like growth factor (PlGF) and soluble fms-tyrosine-like kinase-1 (sFlt-1), soluble endoglin (sEng) and other placental factors) work synergistically to damage the vascular endothelium is discussed. Adverse pregnancy outcomes ultimately are a small contributing factor to the complex pathophysiological process of cardiovascular disease in patients with SLE. Future collaborative studies between cardiologists, obstetricians, obstetric physicians and rheumatologists may pave the way for a better understanding of a likely multifactorial aetiological process.

Download Full-text

Connective tissue disease-associated pulmonary arterial hypertension in Chinese patients

European Respiratory Journal ◽

10.1183/09031936.00182813 ◽

2014 ◽

Vol 44 (4) ◽

pp. 963-972 ◽

Cited By ~ 52

Author(s):

Yan-Jie Hao ◽

Xin Jiang ◽

Wei Zhou ◽

Yong Wang ◽

Lan Gao ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Pulmonary Arterial Hypertension ◽

Connective Tissue ◽

Arterial Hypertension ◽

Connective Tissue Disease ◽

Lupus Erythematosus ◽

Chinese Patients ◽

Systemic Lupus ◽

Pulmonary Arterial

We sought to investigate the characteristics, survival and risk factors for mortality in Chinese patients with connective tissue disease (CTD)-associated pulmonary arterial hypertension (APAH) in modern therapy era.129 consecutive adult patients who visited one of three referral centres in China with a diagnosis of CTD-APAH confirmed by right heart catheterisation during the previous 5 years were enrolled. The end-point was all-cause death or data censoring.Systemic lupus erythematosus was the most common underlying CTD (49%) and systemic sclerosis just accounted for 6% in this cohort. The overall survival at 1 and 3 years was 92% and 80%, respectively. Pericardial effusion, a shorter 6-min walk distance, lower mixed venous oxygen saturation, higher pulmonary vascular resistance (PVR) and alkaline phosphatase (ALP), and lower total cholesterol levels were all associated with a higher risk of death among the study population. Higher PVR and ALP were independent predictors of mortality.In conclusion, unlike in western patients, systemic lupus erythematosus is the most common underlying disease in Chinese patients with CTD-APAH. The survival of Chinese patients with CTD-APAH in the modern treatment era is similar to that in western countries. Elevated PVR and ALP are independent risk factors for poor outcomes.

Download Full-text

Infection in Southern Chinese Patients with Systemic Lupus Erythematosus: Spectrum, Drug Resistance, Outcomes, and Risk Factors

The Journal of Rheumatology ◽

10.3899/jrheum.151523 ◽

2016 ◽

Vol 43 (9) ◽

pp. 1650-1656 ◽

Cited By ~ 24

Author(s):

Dongying Chen ◽

Jingyi Xie ◽

Haihong Chen ◽

Ying Yang ◽

Zhongping Zhan ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Viral Infection ◽

Fungal Infection ◽

Lupus Erythematosus ◽

Renal Involvement ◽

Hospitalized Patients ◽

Chinese Patients ◽

Systemic Lupus ◽

Accumulated Dose

Objective.To investigate the spectrum, antibiotic-resistant pattern, risk factors, and outcomes of infection in patients hospitalized with systemic lupus erythematosus (SLE).Methods.We collected the clinical and microbiological data from hospitalized patients with SLE with infection between June 2005 and June 2015, and then conducted retrospective analyses.Results.Among our sample of 3815 hospitalized patients, 1321 (34.6%) were diagnosed with infection. The majority (78.3%) of infection occurred within 5 years of SLE onset. Bacterial infection was predominant (50.6%), followed by viral infection (36.4%) and fungal infection (12.5%). The lungs (33.7%) and upper respiratory tracts (26.3%) were most commonly affected. Gram-negative bacteria (GNB) were predominant over gram-positive bacteria (178 isolates vs 90 isolates). The most frequently isolated bacteria were Escherichia coli (24.6%), followed by Acinetobacter baumannii (13.4%) and coagulase-negative Staphylococcus (13.4%). Multidrug-resistant (MDR) strains were detected in 26.9% of bacterial isolates. The most common fungus was Candida spp. (99 episodes), followed by Aspergillus (24 episodes) and Cryptococcus neoformans (13 episodes). The overall mortality rate for this cohort was 2.2%; 48 patients died of infection. Factors associated with bacterial and viral infection were higher Systemic Lupus Erythematosus Disease Activity Index, renal involvement, thrombocytopenia, accumulated dose of glucocorticoids (GC), and treatment with cyclophosphamide (CYC). Renal involvement, accumulated dose of GC, and treatment with CYC were associated with fungal infection.Conclusion.Infection was the leading cause of mortality in patients hospitalized with SLE. There were some notable features of infection in Chinese patients including early onset, higher proportion of respiratory tract involvement, predominance of GNB with emergence of MDR isolates, and a variety of pathogens.

Download Full-text

Imaging Assessment of Cardiovascular Disease in Systemic Lupus Erythematosus

Clinical and Developmental Immunology ◽

10.1155/2012/694143 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 14

Author(s):

Sara C. Croca ◽

Anisur Rahman

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Lupus Erythematosus ◽

Current Status ◽

Systemic Lupus ◽

Cardiovascular Morbidity And Mortality ◽

Increased Risk ◽

Cardiovascular Assessment

Systemic lupus erythematosus is a multisystem, autoimmune disease known to be one of the strongest risk factors for atherosclerosis. Patients with SLE have an excess cardiovascular risk compared with the general population, leading to increased cardiovascular morbidity and mortality. Although the precise explanation for this is yet to be established, it seems to be associated with the presence of an accelerated atherosclerotic process, arising from the combination of traditional and lupus-specific risk factors. Moreover, cardiovascular-disease associated mortality in patients with SLE has not improved over time. One of the main reasons for this is the poor performance of standard risk stratification tools on assessing the cardiovascular risk of patients with SLE. Therefore, establishing alternative ways to identify patients at increased risk efficiently is essential. With recent developments in several imaging techniques, the ultimate goal of cardiovascular assessment will shift from assessing symptomatic patients to diagnosing early cardiovascular disease in asymptomatic patients which will hopefully help us to prevent its progression. This review will focus on the current status of the imaging tools available to assess cardiac and vascular function in patients with SLE.

Download Full-text

Cardiovascular disease in systemic lupus erythematosus

Rheumatology and Immunology Research ◽

10.2478/rir-2021-0022 ◽

2021 ◽

Vol 2 (3) ◽

pp. 157-172

Author(s):

Maureen McMahon ◽

Richard Seto ◽

Brian J. Skaggs

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Cardiovascular Disease ◽

Lupus Erythematosus ◽

Cardiovascular Events ◽

Subclinical Atherosclerosis ◽

Cardiac Risk ◽

Systemic Lupus ◽

Cardiac Risk Factors ◽

Increased Risk

Abstract There is a well-known increased risk for cardiovascular disease that contributes to morbidity and mortality in systemic lupus erythematosus (SLE). Major adverse cardiovascular events and subclinical atherosclerosis are both increased in this patient population. While traditional cardiac risk factors do contribute to the increased risk that is seen, lupus disease-related factors, medications, and genetic factors also impact the overall risk. SLE-specific inflammation, including oxidized lipids, cytokines, and altered immune cell subtypes all are likely to play a role in the pathogenesis of atherosclerotic plaques. Research is ongoing to identify biomarkers that can help clinicians to predict which SLE patients are at the greatest risk for cardiovascular disease (CVD). While SLE-specific treatment regimens for the prevention of cardiovascular events have not been identified, current strategies include minimization of traditional cardiac risk factors and lowering of overall lupus disease activity.

Download Full-text

Adipokines and Systemic Lupus Erythematosus: Relationship with Metabolic Syndrome and Cardiovascular Disease Risk Factors

The Journal of Rheumatology ◽

10.3899/jrheum.080503 ◽

2009 ◽

Vol 36 (2) ◽

pp. 295-297 ◽

Cited By ~ 72

Author(s):

MARTA VADACCA ◽

DOMENICO MARGIOTTA ◽

AMELIA RIGON ◽

FABIO CACCIAPAGLIA ◽

GIUSY COPPOLINO ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Cardiovascular Disease ◽

Metabolic Syndrome ◽

Lupus Erythematosus ◽

Disease Risk ◽

Activity Index ◽

Cardiovascular Disease Risk ◽

Systemic Lupus ◽

The Metabolic Syndrome

Objective.To study concentrations of adipokines in patients with systemic lupus erythematosus (SLE) and the relationship among adipokines, the metabolic syndrome (MeS), and cardiovascular disease (CVD) risk factors.Methods.We enrolled 50 SLE patients and 26 controls, all women. Leptin, resistin, visfatin, and adiponectin were measured by commercial ELISA kits.Results.MeS prevalence was increased among subjects with SLE. Leptin levels were higher in patients with SLE than controls. Among SLE patients, independent determinants of leptin were insulin levels (p < 0.0001), triglycerides (p = 0.03), body mass index (p = 0.02), corticosteroid dosage (p = 0.02), and SLE Disease Activity Index (p = 0.005). Other adipokines did not differ between SLE patients and controls.Conclusion.Leptin was increased in SLE patients and could play a role in SLE-related cardiovascular diseases.

Download Full-text