Arterial Stiffness in Systemic Lupus Erythematosus and Its Correlation with Disease Severity: A Case Control Study

Introduction: Arterial  stiffness  is  an  emerging  field  of  interest  in  atherosclerosis. Patients  with systemic lupus erythematosus (SLE) are predisposed to have premature atherosclerosis.

Aims: To compare the arterial stiffness among patients with SLE and non-SLE controls. The study also compared arterial stiffness among SLE patients in relation to disease activity (SLEDAI) and end organ damage (SLICC index).

Study Design: Case control study.

Place and Duration of Study: Patients attending rheumatology clinic and those admitted to medical wards of the Internal Medicine and Nephrology departments of Government Medical College Hospital, Thiruvananthapuram.

Methodology: 53  SLE  patients  and  53  non-SLE  controls  were  studied.  Data  was  obtained  in  a structured format. Arterial stiffness indices were obtained by measuring the brachial ankle pulse wave velocity (baPWV). The SLEDAI Score and SLICC Damage index were measured in the SLE group. Age-matched controls were obtained from the general population.

Results: SLE patients had higher brachial ankle pulse wave velocity (baPWV) than the control non-SLE population (1194.9 ± 169.6 cm/s vs 1008.5 ± 62.5 cm/s; p<0.001), Mean arterial stiffness index (ASI) among SLE patients was significantly higher than that of control (26.2 ± 3.9 mm Hg vs. 23.7 ± 3.7 mm Hg, p=.001), mean augmentation index(AI) among SLE patients was significantly higher when compared with the control non-SLE population (13.9± 6.7% vs 6.2 ± 1.7%, p<0.001). Patients with SLE-related  end  organ  damage  (SLICC  index ≥1)  had  baPWV  elevated  over  those  with  SLICC index=0  (1234.5  ±  181.5  cm/s.1  vs  1124.1  ±  121.1  cm/s,  p=.021).  No  significant  difference  was observed between the mean ASI among the patients with SLICC index ≥1 and those with SLICC=0. (26.9  ±  4.1  mm  Hg  vs  24.8  ±  3.3  mm  Hg,  p=.070),  and  mean  AI  among  SLICC  index ≥1  was significantly higher than that of SLICC index ≥1 (15.6 ± 6.7% vs 11.1 ± 5.8%, p= .017). Patients with high disease activity (SLEDAI ≥6) had baPWV of 1278.9 ± 131.0 cm/s (95%CI 1229 cm/s.1-1328.7 cm/s)  vs  (1093.4  ±  156.5  cm/s;  95%  CI  1027.3  cm/s -1159.4  cm/s  p<0.001)  when  compared  with those having low activity (SLEDAI<6).

Conclusion: Patients with SLE had increased arterial stiffness. End organ damage and high disease activity  among  SLE  patients  correlated  to  increased  arterial  stiffness,  and  is contributory  to  an increased risk of atherosclerosis.

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