Access: Lupus Research -- Cardiovascular Disease
Research Summaries from 2012
Steroid-Related Risk of Heart Disease in Lupus
Individuals with lupus are at increased risk of cardiovascular (heart) disease as compared to those from the general population, even after adjustment for traditional risk factors (such as high blood pressure or cholesterol). However, whether this occurs due to lupus disease activity, lupus-related autoantibodies, and/or the use of specific kinds of medications is unclear. 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. These findings suggest that, in these individuals, the short-term impacts of steroids are, in general, even more influential in determining heart disease risk than the cumulative dose over time.
C-Reactive Protein as a Lupus Biomarker
C-reactive protein (CRP) has been studied as a lupus biomarker, but its exact role in lupus is yet to be elucidated. Most studies of CRP in lupus were unable to detect levels below a certain threshold, which may have limited the accuracy of the results. This study examines the role of CRP with the use of more sensitive methods that can detect very low levels of CRP (high sensitivity C-reactive protein, or hsCRP). The results of this study indicate that hsCRP is detectable in 77% of patients with clinically active lupus. In addition, hsCRP levels correlate with specific facets of lupus disease activity and with a number of factors related to increased cardiovascular disease risk.
Metabolic Syndrome Among Patients With Lupus
Metabolic syndrome is characterized by increased waist circumference and elevations in cholesterol, fats in the blood, blood pressure, and/or fasting blood sugar levels. 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. The results of this study indicate that metabolic syndrome is somewhat common among people with lupus and that specific factors related to lupus and its treatments significantly increase its risk. In addition, lupus patients from specific minority groups are at especially increased risk of developing metabolic syndrome.
Interferon-Associated Risk for Premature Heart Disease Among People with Lupus
People with lupus are at increased risk for premature heart disease. Among lupus patients, lupus disease activity is even more important than traditional risk factors for heart disease. Type I interferon, a protein which plays a major role in the etiology of lupus, may have a significant role in the development of premature heart disease in people with lupus. The researchers examined the relationship between type I interferon and premature heart disease among people with lupus and also among women who do not have lupus or other related diseases. Three specific indicators of premature heart disease was studied in these populations. The researchers identify specific heart-related factors that lupus patients should work with their doctors to monitor over time.
First Ever Study of Cholesterol-Lowering Drugs in Children With Lupus
Adults with lupus are at increased risk for developing cardiovascular disease as compared to the general population. Increased levels of blood cholesterol can result in atherosclerosis, or hardening of the arteries, which is itself a risk factor for cardiovascular disease. Previous studies indicate that subclinical atherosclerosis may be present in children with lupus. Since atherosclerosis is now known to begin in childhood, even in healthy people, the risk of developing atherosclerosis and cardiovascular disease has become a growing concern for the health of children with lupus. This study examined the safety and efficacy of atorvastatin (Lipitor®), a cholesterol-lowering drug, in children with lupus over a three-year period. The results suggest that lipid-lowering drugs like atorvastatin can safely and effectively reduce cholesterol levels in children with lupus. However, the effects of this treatment regimen do not warrant administration of lipid-lowering drugs to all children with lupus and future studies may indicate specific subpopulations that could benefit most.
Optimizing Assessment of Heart Disease Risk in People with Lupus
Lupus is associated with an increased risk for developing cardiovascular disease. Previous studies indicate that this increased risk cannot be fully accounted for by traditional risk factors, such as high cholesterol or blood pressure. Heart disease risk is typically assessed based on, at least in part, measurement of blood pressure and cholesterol levels at a certain point in time for a person of a given sex and age. However, recent studies suggest that cholesterol and blood pressure can vary considerably over time in people with lupus. This study examined whether heart disease risk could be better predicted in people with lupus when multiple measures of cholesterol and blood pressure were taken over time. The results suggest that traditional methods of blood pressure assessment (such as single-point-in-time measures) tend to underestimate its potential role in the development of heart disease and do not predict heart disease-related outcomes in people with lupus. Potential strategies to better assess heart disease risk in people with lupus are discussed.
Research Summaries from 2011
Lack of Cardiovascular Risk Assessment in a Canadian Population of Lupus Patients
People with lupus have an increased risk of heart disease and stroke due to premature hardening of the arteries. This increased risk is due in part to traditional risk factors and in part due to lupus-specific immune dysfunction. The researchers aimed to evaluate how effectively risk for heart disease was being assessed in a population of lupus patients being cared for in Alberta, Canada.
Research Summaries from 2010
Heart Disease May Precipitate Depression in Certain People with Lupus
Depression occurs commonly in people with lupus, as does heart disease. However, it is unknown whether one may trigger or contribute to the development of the other. Increased understanding of factors that may contribute to depression in people with lupus can aid future strategies to prevent and treat depression in people with lupus. The researchers hoped to learn about lupus-related factors that may contribute to the development of depression in people with lupus. The participants were interviewed annually about their health statuses for up to five years. The researchers used statistical methods to determine whether specific lupus-related factors could predict the development of another. The following were found to be predictors of depression in people with lupus regardless of the statistical methods used: being aged 40-59, having less than a full college education, being Hispanic/Latino, and having some form of depression upon entry to the study. Increased education seems to have a protective effect against developing depression in people with lupus. Identifying lupus patients at risk for developing depression could greatly increase their quality of life since there are many effective treatment options for depression.
Lupus Antibodies Related to Persistent Disease Activity and Heart Disease
People with lupus are at increased risk for developing heart disease. It is known that lupus patients make antibodies that could interfere with some of the proteins that control cholesterol. Since unregulated cholesterol is a risk factor for heart disease, it is possible that these particular antibodies might increase the risk for this in lupus patients. The researchers hoped to learn whether antibodies to cholesterol regulators are associated with disease activity or heart disease in people with lupus.
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Anti-malarial Drugs Decrease Risk of Blood Clots in People with Lupus
Many study reports have suggested that people with lupus have an increased risk for blood clots, but the degree of this increased risk has varied widely across studies. In addition, previous studies have found that anti-malarial drugs such as hydroxychloroquine (Plaquenil) may decrease the risk for blood clots, but the patients in these studies might have had different amounts of these treatments, or had differing severity of lupus for differing amounts of time. This could have led to confusion about whether it was the Plaquenil protecting these patients or some other factors. In this study, the researchers hoped to determine the risk of developing blood clots in people with lupus, while factoring in the year of diagnosis and disease severity.
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Risk Factors for Heart Disease in People with Lupus
Although it is known that people with lupus are at greater risk for coronary heart disease (CHD), very little is known about which people with lupus really are at risk and which are not. This study confirms certain “classic” risk factors for CHD like high cholesterol or blood pressure, smoking, and a family history of CHD, as well as some lupus-related characteristics (i.e., azathioprine treatment, high creatinine levels), which might increase CHD risk.
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Study Finds Risk Factors for Heart Disease in People With Lupus
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. The researchers hoped to learn what characteristics of lupus patients might help to predict heart disease.
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Research Summaries from 2009
Antiphospholipid Antibodies: It May Matter Which Ones You Have
One-third of people with lupus test positive for antiphospholipid antibodies (aPLs). The aPLs are a group of antibodies that interact with proteins that regulate blood clotting and blood vessel stability. Antiphospholipid antibodies can interfere with the normal function of blood vessels in various ways, which in turn can lead to complications such as immediate blood clots in arteries or veins, miscarriages, or more long-term damage to blood vessels, including hardening of the arteries (atherosclerosis) and later onset of heart disease and strokes.
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Research Summaries from 2008
Olés for Omega-3s
Omega-3 polyunsaturated oils found in fish have been proven to help lower risk for heart disease. This could be relevant to lupus since there is a known increased risk for heart disease in people with lupus.
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Assessing the risk factors for heart disease
Coronary artery disease (CAD) is a serious condition characterized by the buildup of fatty deposits called plaque along the inside walls of arteries that supply blood to the heart. This build-up of plaque is known as atherosclerosis, and is commonly referred to as "hardening of the arteries." People with lupus may have additional risks for developing premature atherosclerosis, either from inflammation in the blood vessels or as a side effect of some of the medications they may take.
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Lupus as a risk factor for heart disease
People with lupus have risks for coronary heart disease (CHD), in part because they exhibit some of the "traditional" risk factors that other patients share and also possibly as a result of lupus disease activity and the medications used to treat it. These risks may sometimes be hard to separate out, since lupus inflammation and/or treatments may have direct or indirect effects on traditional risk factors.
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Vitamin D deficiency and heart disease
Vitamin D is an essential element that promotes bone growth, contributes to the immune system, and plays a role in a number of other cellular functions. Low levels of vitamin D have been associated with osteoporosis, type 2 diabetes, autoimmune diseases, and cardiovascular disease -- and it is estimated that one-third to one-half of all otherwise healthy middle-aged or elderly people have a vitamin D deficiency.
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Detecting damage to arterial walls
People with lupus have an increased risk for developing atherosclerosis, commonly referred to as "hardening of the arteries." As the disease progresses, the walls of the arteries -- called the intima media -- thicken, and the passage through which the blood flows narrows as fatty plaque deposits build up along the walls of the arteries.
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A Clue to Congenital Heart Block
Neonatal lupus is a condition that can occur when anti-SSA/Ro antibodies cross the placenta in pregnancy from the mother to her developing baby. Babies born to women who are positive for anti-SSA/Ro antibodies (even those who do not have lupus) are at greater risk for neonatal lupus, although this remains rare. A number of symptoms are seen in infants who are born with neonatal lupus, most commonly skin rashes or liver involvement, which go away over time as the infant’s own immune system develops, and the mothers antibodies are cleared from the baby’s system. Even more rarely, however, there is a potentially life-threatening heart condition that these babies can be born with, called congenital heart block (CHB).
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Is Hormone Replacement Therapy During Menopause Safe for Women with Lupus?
Data from two very large studies -- the HERS trial (for Heart and Estrogen/Progestin Replacement Study) and the Women’s Health Initiative -- have raised questions about the use of hormone replacement therapy (HRT) for women during menopause; those studies seemed to show that HRT increases a woman’s risk for heart disease. This is of even greater concern for women with lupus, because lupus puts women at higher risk for heart disease.
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Research Summaries from 2007
Cardiovascular disease activity in lupus -- even during remission?
Lupus patients are at increased risk for cardiovascular disease (CVD), which involves hardening of the arteries and can lead to heart attacks or strokes later in life. People with CVD may have fewer special cells in their blood that help repair damaged blood vessels. This group of researchers wanted to learn if lupus patients had lower levels of these helper cells, even when they were in remission. The findings revealed that the levels of the repair cells were lower in lupus patients leading the researchers to conclude that for some lupus patients, the ability to repair damaged blood vessels may be impaired, even if the patients are in remission and on medication.
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Diabetes Drugs Might Help Prevent Heart Disease in Lupus
Some of the same problems that can occur in blood vessels in patients with diabetes may also be at work in lupus patients, increasing their risk for heart disease and strokes through the activity of a small inflammatory protein called interleukin-18.
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