Atherosclerosis Accelerated in Patients With Lupus

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Atherosclerosis Accelerated in Patients With Lupus

NEW YORK

(Reuters Health) Dec 17 - Systemic lupus erythematosus

(SLE) is an independent risk factor for atherosclerosis, according to two

reports in the December 18th issue of The New England Journal of Medicine. Data

suggest that aggressive immunosuppressive therapy may decrease the risk of

plaque deposition in vascular walls.

Conventional

wisdom holds that premature atherosclerosis is due to traditional risk factors

exacerbated by treatment with corticosteroids, Dr. J. Roman and associates

note in the first paper. Only recently has atherosclerosis been attributed to

lupus itself (see Reuters Health report, November 14, 2001).

Dr.

Roman, of the Weill Medical College of Cornell

University in New York,

and her team conducted a case-control study that included 197 patients with

lupus and 197 control subjects matched for age, gender, race

and hypertension status. Carotid artery ultrasonography

was used to identify plaque.

Overall,

the relative risk of atherosclerosis was 2.4-times higher in patients compared

with controls. The discrepancy was larger in younger age groups: Among

individuals age 40 and younger, the prevalence was 13.4% versus 2.4% in control

subjects. For those in their fifth decade of life, the prevalence was 33.3% and

13.2%, respectively.

Logistic-regression

analysis revealed an association between plaque and duration of disease, a

higher damage-index score, and lack of immunosuppressive therapy.

Thus, the

authors conclude, " More vigorous therapy might decrease the likelihood and

burden of atherosclerosis in patients with lupus and, perhaps, in those with

other chronic inflammatory diseases. " Restricting immunosuppressive

therapy to clinical flares may therefore be inadequate for controlling the atherogenic component of SLE.

In the

second article, Dr. Yu Asanuma, at Vanderbilt University School of Medicine in Nashville,

and colleagues used electron beam computed tomography to identify

coronary-artery calcification in 65 patients with lupus and 69 matched control

subjects.

Calcifications

were present in 20 patients and 6 controls. After adjusting for smoking

history, hypertension, triglyceride and homocysteine

levels, patients were nearly 10 times more likely to exhibit coronary artery

calcification.

Both

teams found that conventional cardiovascular risk factors did not predict

atherosclerosis in patients with lupus.

In a

related editorial, Dr. Bevra Hannahs

Hahn recommends that physicians consider therapy with statins

or other anti-atherosclerosis interventions if hyperlipidemia

or hypertension occurs during periods of stable disease.

According

to the clinician, who is from the Geffen School of Medicine at the University

of California Los Angeles,

" The current standard of care should include efforts to suppress SLE and

prevent atherosclerosis. "

Much

Love,

Deanna

LUPUS

Serenity Prayer...

Lord, grant me the

serenity to accept the things I cannot change, the courage to change the things

I can, and the wisdom to hide the bodies of doctors I shot when they said,

You're perfectly healthy, it's all in your head "