Metabolic syndrome is marked by increased risk of cardiovascular diseases, so its incidence among people with lupus can indicate risk of cardiovascular disease in lupus patients.
Study Finds Risk Factors for Heart Disease in People With Lupus
Predictors of the first cardiovascular event in patients with systemic lupus erythematosus – a prospective study.
Authors: Gustafsson J, Gunnarsson I, Börjesson O, Pettersson S, Möller S, Fei GZ, Elvin K, Simard JF, Hansson LO, Lundberg IE, Larsson A, and Svenungsson E. (2009).
Arthritis Research & Therapy 11:R186, epub ahead of print December 9.
What is the topic?
Some people with lupus seem to be at increased risk for heart disease. It would be very helpful to know about specific factors that could help to predict this risk.
What did the researchers hope to learn?
The researchers hoped to learn what characteristics of lupus patients might help to predict heart disease.
Who was studied?
182 lupus patients in Sweden, with no history of heart problems, were studied over a period of time that averaged about eight years.
How was the study conducted?
In initial studies, a rheumatologist evaluated all the patients. Blood samples from each patient were analyzed by people who did not know their medical history. In follow-up studies, the same patients were examined in person, if possible, or interviewed by phone.
What did the researchers find?
Lupus patients who developed heart disease were older, more likely to be smokers, and to have higher cholesterol and blood pressure. They were also more likely, at the time of initial studies, to have had lupus for a longer time, have arthritis, antiphospholipid antibodies, and blood tests suggesting kidney damage.
When the age of the patients was factored out, the following were found to still be predictors of heart disease in lupus patients: smoking, arthritis, low levels of a blood protein called "albumin" (which is often low in kidney disease), antiphospholipid antibodies, inflammation of the lining of the lungs, and factors that regulate blood vessel inflammation and blood clotting. People with antibodies (immune factors) that are associated with Sjogren’s syndrome seemed to be at less risk.
What were the limitations of the study?
This was a relatively small study and a lot of questions were being asked at once, making it more likely that some of the associations they found were a coincidence. Most of the patients were European, so additional studies would be needed to find out if these results apply to patients of other backgrounds. Because there were only patients with lupus in the study, it was not possible to estimate the frequency of heart disease in lupus compared to the general population.
What do the results mean for you?
The results suggest that some measurable features of lupus may contribute to the risk for heart disease, particularly those associated with kidney disease, blood vessel inflammation, or how blood clotting is regulated. Knowing more about these specific things through further studies might help to find better preventative medicine for lupus patients. Meanwhile, traditional risk factors such as smoking remain important for people with lupus and should not be ignored.
The results of this study indicate that current use of steroids (20 mg/day or more) is perhaps the most significant risk factor for heart disease in individuals with lupus.