291 Assessment of the QRISK2, QRISK3, SLE cardiovascular risk equation, modified framingham and framingham risk calculators as predictors of cardiovascular disease events in systemic lupus erythematosus

Objective: Systemic lupus erythematosus (SLE) is associated to boosted atherosclerosis development and a higher cardiovascular disease risk. This study aimed to delineate the role of anti-double stranded DNA (anti-dsDNA) antibodies on the molecular profile and the activity of immune and vascular cells, as well as on their enhanced cardiovascular risk. Approach and Results: Eighty SLE patients were included. Extensive clinical/analytical evaluation was performed, including cardiovascular disease parameters (endothelial function, proatherogenic dyslipidemia, and carotid intima-media thickness). Gene and protein expression profiles were evaluated in monocytes from patients diagnosed positive or negative for anti-dsDNA antibodies by using NanoString and cytokine arrays, respectively. NETosis and circulating inflammatory profile was assessed in both neutrophils and plasma. Positivity and persistence of anti-dsDNA antibodies in SLE patients were associated to endothelial dysfunction, proatherogenic dyslipidemia, and accelerated atherosclerosis. In parallel, anti-dsDNA antibodies were linked to the aberrant activation of innate immune cells, so that anti-dsDNA(+) SLE monocytes showed distinctive gene and protein expression/activity profiles, and neutrophils were more prone to suffer NETosis in comparison with anti-dsDNA(−) patients. Anti-dsDNA(+) patients further displayed altered levels of numerous circulating mediators related to inflammation, NETosis, and cardiovascular risk. In vitro, Ig-dsDNA promoted NETosis on neutrophils, apoptosis on monocytes, modulated the expression of inflammation and thrombosis-related molecules, and induced endothelial activation, at least partially, by FcR (Fc receptor)-binding mechanisms. Conclusions: Anti-dsDNA antibodies increase the cardiovascular risk of SLE patients by altering key molecular processes that drive a distinctive and coordinated immune and vascular activation, representing a potential tool in the management of this comorbidity.

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Correction: Development of a systemic lupus erythematosus cardiovascular risk equation

Lupus Science & Medicine ◽

10.1136/lupus-2019-000346corr1 ◽

2020 ◽

Vol 7 (1) ◽

pp. e000346corr1

Keyword(s):

Systemic Lupus Erythematosus ◽

Cardiovascular Risk ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Risk Equation

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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.

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Abstract P166: Cardiovascular Disease Burden Among In-patients With Systemic Lupus Erythematosus

Circulation ◽

10.1161/circ.141.suppl_1.p166 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Laura P Kimble ◽

Sandra B Dunbar ◽

Elizabeth J Corwin ◽

Rebecca Mitchell ◽

Ignacio Sanz ◽

...

Keyword(s):

Heart Failure ◽

Systemic Lupus Erythematosus ◽

Cardiovascular Disease ◽

Renal Failure ◽

African American ◽

Cardiovascular Risk ◽

Supraventricular Tachycardia ◽

Lupus Erythematosus ◽

Disease Burden ◽

Systemic Lupus

Introduction: Systemic lupus erythematosus (SLE) disproportionately affects minority women of childbearing age and is associated with increased cardiovascular risk. Understanding concomitant cardiovascular co-morbidities in the SLE population is essential to reduce their excess cardiovascular burden through targeted risk reduction. Purpose: This study examined cardiovascular co-morbidities in persons with SLE admitted to an acute care hospital. Method: We conducted a secondary data analysis of de-identified electronic health record (EHR) data from a random sample of 1,000,000 patients who received care from a healthcare system in the southeastern US between the years of 2012 and 2018. We targeted the specific patient encounter of the first hospitalization in which SLE was included as a discharge diagnosis and examined cardiovascular co-morbidities present in the cohort. Results: We identified 320 patients (89% women n=285/320, 84.4% n=270/320 African-American) with a mean age of 47.1 ± 16.4 years and length of stay (LOS) of 6.7 ± 8.1 days. The majority were hospitalized on an emergent basis (61%, n=195/320) with 44.4% (n=143/320) admitted to hospital medicine/internal medicine specialties. Admission to cardiology/cardiovascular surgery specialties was noted for 7.5% (n=27/320). The majority were discharged to home for self-care (70.9%, n=227/320) or home health services (12.5%, n=40/320). Potential SLE complications were evident with 23.7% (n=76/320) noted to have renal failure. The most common cardiovascular diagnoses documented in the EHR included: hypertension (40%, n=192/320), heart failure (18.4%, n=59/320), coronary artery disease (16.6%, n=50/320), mitral valve disorders (9.7%,n=31/320), atrial fibrillation (8.7%, n=27/320), supraventricular tachycardia (6.6%,n=21/320), acute myocardial infarction (6.2%,n=20/320), cerebral vascular accident (5.9%, n=19/320), endocarditis (4.1%,n=13/320), and peripheral vascular disease (3.7%, n=12/320). Longer LOS was associated with renal failure (r= .25, p = .001), heart failure (r= .20, p = .001), and supraventricular tachycardia (r=.22, p = .001). A greater proportion of men had endocarditis (14.3%, n=5/35), PVD (11.4%,n = 4/35), and CAD (28.6%, n=10/35) compared to women (endocarditis: 2.8%, n=8/285, p =.008; PVD 2.8%, n=8/285, p= .032; CAD 14.0% n=40/285, p=.044). Conclusion: Cardiovascular disease burden was evident in this predominantly young, female, African-American SLE inpatients. Cardiac diagnoses were associated with increased LOS and men with SLE had greater cardiovascular burden related to CAD and PVD compared to women. These findings highlight the importance of cardiovascular risk reduction interventions and aggressive management of cardiovascular comorbidities in the SLE population.

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Metabolomics in juvenile-onset SLE: identifying new biomarkers to predict cardiovascular risk

10.1101/19000356 ◽

2019 ◽

Cited By ~ 1

Author(s):

George A Robinson ◽

Kirsty E Waddington ◽

Leda Coelewij ◽

Ania Radziszewska ◽

Chris Wincup ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Atherosclerotic Plaque ◽

Lupus Erythematosus ◽

Metabolomic Analysis ◽

Systemic Lupus ◽

Juvenile Onset ◽

Onset Systemic Lupus Erythematosus ◽

Group 1

ABSTRACTBACKGROUNDJuvenile-onset systemic lupus erythematosus (JSLE) is an autoimmune disorder characterised by immune dysregulation, chronic inflammation and increased cardiovascular risk (CVR). Cardiovascular disease is the leading cause of mortality in JSLE patients not attributable to disease flares. However, it is not possible to predict those patients at greatest risk using traditional CVR factors.METHODSSerum metabolomic analysis was performed using a nuclear magnetic resonance spectroscopy-platform in 31 JSLE patients. Data was analysed using cluster, linear regression and receiver operating characteristic analysis. Results were validated in a second cohort of 31 JSLE patients and using data from a cohort of adult-onset SLE patients with known pre-clinical atherosclerotic plaque.RESULTSUnbiased hierarchical clustering of metabolomic data identified three patient groups. Group-1 had decreased atheroprotective high density lipoproteins (HDL) and increased atherogenic very low and low density lipoproteins (VLDL/LDL); Group-2 had elevated HDL but reduced VLDL/LDL; and Group-3 had low HDL/VLDL/LDL levels. Notably, apolipoprotein(Apo)B1:ApoA1 ratio, a known CVR marker in adult cohorts, was elevated in Group-1 JSLE patients compared to Groups-2/3. The metabolomic signature was validated in a second JSLE cohort and compared with lipid biomarkers previously associated with pre-clinical atherosclerotic plaque in adult SLE patients. Linear regression analysis accounting for demographics, treatment, disease activity, lupus serological markers and body mass index confirmed that a unique metabolomic profile could differentiate between JSLE patients at high and low CVR.CONCLUSIONSPatient stratification using ApoB:ApoA1 ratio and lipoprotein signatures could facilitate tailored lipid modification therapies and/or diet/lifestyle interventions to combat increased CVR in JSLE.Key messagesWhat is already known about the subject?Cardiovascular disease is the leading cause of mortality in juvenile-onset systemic lupus erythematosus (JSLE) not attributable to lupus flares; the cardiovascular risk of JSLE patients is 300 times higher than age matched healthy individuals. It is not possible to predict those patients at greatest risk using traditional risk factors.What does this study add?In depth lipoprotein-based metabolomic analysis identified Apolipoprotein(Apo)B :ApoA1 ratio as a potential biomarker for predicting increased cardiovascular risk in JSLE. This was validated in a second patient cohort and using metabolic signatures associated with pre-clinical atherosclerotic plaque development in adult SLE patients.How might this impact on clinical practice or future developments?Predicting cardiovascular risk in young JSLE patients using ApoB:ApoA1 ratio could help to stratify patients and identify those who would benefit the most from existing lipid targeting therapies. Reducing cardiovascular risk at a young age could improve patient’s life expectancy and quality of life and reduce cardiovascular comorbidity in later life.

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AB0326 USEFULNESS OF THE INTIMA-MEDIA THICKNESS INDEX BY CAROTID DOPPLER IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS OF HOSPITAL DOCENTE PADRE BILLINI, DOMINICAN REPUBLIC

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2750 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1188.1-1188

Author(s):

J. Santana Peralta ◽

T. Polanco Mora ◽

A. Cornelio ◽

Y. Cruz ◽

E. Rodriguez Bautista ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Lupus Erythematosus ◽

Intima Media Thickness ◽

Healthy Controls ◽

Inclusion Criteria ◽

Systemic Lupus ◽

Low Activity ◽

Carotid Doppler

Background:Systemic lupus erythematosus (SLE) is a multisistemic autoimmune disease. 1There are studies where the increase in the thickness of the intimate/media average in carotid (IMT) is valued, most have shown increase2. Cardiovascular disease is one of the leading causes of morbidity, especially due to its precocity, which occurs in women during the fertile potential, is associated with a higher prevalence of cardiovascular disease (CVD), due to accelerated atherosclerosis3,4,5. Patients with rheumatic diseases have an increased cardiovascular risk due to systemic inflammation and endothelial dysfunction, which promotes accelerated atherosclerosis2. Values below 0.9mm of IMT are considered normal.Objectives:Evaluate the thickness of the intimate/media average in carotid in patients with systemic lupus erythematosus.Methods:Prospective, Observational, cross-sectional study. Carotid Doppler was performed on patients in the outpatient clinic with a diagnosis of SLE from November 2019 to 2020 of the rheumatology service of the Hospital Docente Padre Billini and healthy controls. Inclusion criteria: > 18 years old, SLE diagnosis with ACR 2007 classification criteria, carotid Doppler, measurement of IMT. Controls without disease, matched by sex and age. The data was analyzed with SPSS V23.Results:116 patients with SLE. 95 patients met inclusion criteria;95 healthy controls were included. 97.8% female. Average disease of 6.23 years. 71. 57% (68) use glucocorticoids, antimalarials 70.52% (67), 38.94% (37) mofetil mycophenolate, 20% (19) methotrexate, 11. 57% (11) rituximab, 5.26% (5) azathioprine, 1.05% (1) cyclosporine, 1.05% (1) cyclophosphamide and 0.86% (1) tacrolimus. Dyslipidemia (63.1%) (73), obesity 34.7% (33), high blood pressure 23.1% (22), diabetes 3.44% (4), smokers 0% (0). The carotid doppler with SLE showed 17.89% (17) atheromatous plates, 29.4% (5) calcified plates, Carotid Doppler in healthy controls showed 20% (19) atheromatous plates, 36.84% (7) calcified plates. The activity rate using SLEDAI showed 68.96% (80) without activity, 13.79% (16) low, 11.20% (13) moderate, 6.03% (7) high activity. 78% (75) patients with SLE had increased IMT mean (SD) 2.15mm (0.99). About control 71.57% (68) had an increase of IMT, mean (SD) 1.27mm (1.07) (p-0.046).Conclusion:Our study found that most patients with SLE had IMT increase. The activity ratio of SLE showed that the vast majority of our patients are in low activity. Alterations in IMT were associated with low SLEDAI and glucocorticoid use. There was no significant difference in the intima-media carotid thickness index with respect to the control group. We suggest the realization of Doppler in patients with SLE despite being in low activity for evaluation and monitoring of cardiovascular risk.References:[1]Hernández Muñiz, Y, Guibert Toledano, Z. and Reyes Llerena, G., 2015. Correlation of C Reactive Protein Figures and Atherosclerosis in Patients with Systemic Lupus Erythematosus.[2]Saldarriaga Rivera, L., Ventura Ríos, L., Hernández Díaz, C. and Pineda Villaseñor, C., 2016. Measurement of the thickness of the intimate-half carotid: utility and ultrasound diagnosis of subcline atherosclerosis in rheumatic diseases. Literature review. Rev Col Reum, 23(2), pp.92-101.[3]Telles, R., Lanna, C., Ferreira, G., Souza, A., Navarro, T. and Ribeiro, A., 2008. Carotid atherosclerotic alterations in systemic lupus erythematosus patients treated at a Brazilian university setting. Lupus, 17(2), pp.105-113.[4]Nienhuis, H., by Leeuw, K., Bijzet, J., van Doormaal, J., van Roon, A., Smit, A., Graaff, R., Kallenberg, C. and Bijl, M., 2010. Small artery elasticity is decreased in patients with systemic lupus erythematosus without increased intima media thickness. Arthritis Research & Therapy, 12(5), p.R181.[5]Frerix et al. Arthritis Research & Therapy 2014, 16: R54Disclosure of Interests:None declared

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AB0325 FREQUENCY OF ATHEROMATOUS PLAQUES IN CAROTID ARTERIES BY DOPPLER IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS, SANTO DOMINGO, DOMINICAN REPUBLIC

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2745 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1187.2-1188

Author(s):

J. Santana Peralta ◽

T. Polanco Mora ◽

A. Cornelio ◽

Y. Cruz ◽

E. Rodriguez Bautista ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Rheumatic Diseases ◽

Lupus Erythematosus ◽

Inclusion Criteria ◽

Systemic Lupus ◽

Atheromatous Plaques ◽

Low Activity ◽

Carotid Doppler

Background:Systemic lupus erythematosus (SLE) is a multisystemic autoimmune disease. 1 Atherosclerosis is considered an alteration of the arteries by the abnormal deposit of lipids and fibrous tissue. 2 Cardiovascular disease is one of the leading causes of morbidity and mortality, especially due to its precocity, which occurs in women during childbearing age, is associated with a higher prevalence of cardiovascular disease (CVD), due to accelerated atherosclerosis3,4,5. Patients with rheumatic diseases have an increased cardiovascular risk due to systemic inflammation and endothelial dysfunction, which promotes accelerated atherosclerosis2.Objectives:Evaluate the frequency of atheromatous plaques in patients with systemic lupus erythematosus.Methods:Observational, prospective, cross-sectional study. Carotid Doppler was performed on patients with SLE from the external consultation of the rheumatology service from November 2019 to 2020. Inclusion criteria: > 18 years old, diagnosis SLE with the classification criteria ACR 2007, realization of Doppler. Controls: no disease, equated by age and sex. The data was analyzed with SPSS V23.Results:116 patients met inclusion criteria, including 116 female controls. Mean sick time was 6.23 years. 14.65% (17) had atheromaus plates, 29.4% calcified plates (5). 34.7% Dyslipidemia (63.1%) (73), obesity 34.7% (33), high blood pressure 23.1% (22), diabetes 3.44% (4), smokers 0% (0). The activity rate using SLEDAI showed 68.96% (80) without activity, 13.79% (16) low, 11.20% (13) moderate, 6.03% (7) high activity. About control group (116), 19.82% (23) showed atheromatous plates, 39.13% (9) calcified plates.Conclusion:Our study shows that less than a quarter of patients have atheromatous plaques in the carotid Doppler. In relation to LES activity, the vast majority are in low activity. We suggest the realization of Carotid Doppler in patients with low activity SLE for evaluation and monitoring of cardiovascular risk. Our study showed that there is no increased risk of atheroma plaque formation in SLE patients, compared to the general population.References:[1]Hernández Muñiz, Y., Guibert Toledano, Z. and Reyes Llerena, G., 2015. Correlation of C Reactive Protein Figures and Atherosclerosis In Patients with Systemic Lupus Erythematosus.[2]Saldarriaga Rivera, L., Ventura Ríos, L., Hernández Díaz, C. and Pineda Villaseñor, C., 2016. Measurement of the thickness of the intimate-half carotid: utility and ultrasound diagnosis of subcline atherosclerosis in rheumatic diseases. Literature review. Rev Col Reum, 23(2), pp.92-101.[3]Telles, R., Lanna, C., Ferreira, G., Souza, A., Navarro, T. and Ribeiro, A., 2008. Carotid atherosclerotic alterations in systemic lupus erythematosus patients treated at a Brazilian university setting. Lupus, 17(2), pp.105-113.[4]Nienhuis, H., by Leeuw, K., Bijzet, J., van Doormaal, J., van Roon, A., Smit, A., Graaff, R., Kallenberg, C. and Bijl, M., 2010. Small artery elasticity is decreased in patients with systemic lupus erythematosus without increased intima media thickness. Arthritis Research & Therapy, 12(5), p.R181.[5]Frerix et al. Arthritis Research & Therapy 2014, 16: R54.[6]Marta, M., Joan T., Stefano B., Chapt 2 - Assessment of Disease Activity in Systemic Lupus Erythematosus, Systemic Lupus Erythematosus, Mosby, 2007.Disclosure of Interests:None declared

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Myocardial Infarction in Systemic Lupus Erythematosus – the Sex Specific Risk Profile

Current Pharmaceutical Design ◽

10.2174/1381612826666201210110809 ◽

2020 ◽

Vol 26 ◽

Author(s):

Marija Vavlukis ◽

Daniela Pop-Gjorceva ◽

Lidija Poposka ◽

Emilija Sandevska ◽

Sasko Kedev

Keyword(s):

Myocardial Infarction ◽

Systemic Lupus Erythematosus ◽

Cardiovascular Risk ◽

Coronary Artery ◽

Young Women ◽

Lupus Erythematosus ◽

Molecular Mechanisms ◽

Clinical Presentation ◽

Systemic Lupus ◽

Antiinflammatory Therapy

Background: Accelerated atherosclerosis is widely present in patients with systemic lupus erythematosus. Objective: The aim of this review is to analyze the relationship between systemic lupus erythematosus and cardiovascular diseases, with the emphasis on acute myocardial infarction. Results: Various molecular mechanisms triggered by infection/inflammation are responsible for endothelial dysfunction and development of atherosclerosis at an earlier age. Contributing factor is the cumulative effect of traditional cardiovascular risk factors interaction with disease related characteristics. Myocardial infarction rates are 2- to 10-fold higher compared to the general population. Young women have the highest relative risk, however, men carry at least 3- fold higher risk than women. Coronary involvement varies from normal coronary artery with thrombosis, coronary microartery vasculitis, coronary arteritis, and coronary atherosclerosis. Typical clinical presentation is observed in men and older women, while atypical is more frequent in young women. Treatment is guided by the underlying mechanism, engaging invasive procedures alone, or accompanied with immunosuppressive and/or antiinflammatory therapy. There are significant gender differences in pathophysiology and clinical presentation. However, they receive the same therapeutic treatments. Conclusion: Systemic lupus erythematosus is a major contributor to atherosclerotic and non-atherosclerotic mechanisms involved in the development of myocardial infarction, which should be taken into account during therapeutic treatment. Although Systemic lupus erythematosus per se is a “female” disease, males are at increased cardiovascular risk and worse outcome. Method: We conducted a literature review through PubMed and Cochrane, using key words: SLE, atherosclerosis, atherothrombosis, coronary artery disease, myocardial infarction, prognosis, sex specifics.

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