CARDIOVASCULAR AFFECTION IN EGYPTIAN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Abstract

SLE is a chronic autoimmune disorder, characterized by production of autoantibodies directed against nuclear and cytoplasmic antigens, which may affect several different organs, with a plethora of different clinical and immunologic abnormalities, characterized by a relapsing and remitting clinical course. Cardiovascular involvement represents the leading cause of mortality in SLE Patients. It's most common manifestations include valvular and pericardial involvement, myocardial dysfunction, conduction disorders, accelerated Atherosclerosis and thromboembolic disease. Pulmonary hypertension and coronary arteritis are seen less often. Traditional cardiovascular risk factors (such as smoking, hypertension and dyslipidemia) contribute, but can’t fully explain the high prevalence of CVD in SLE. Besides traditional risk factors, disease activity, chronic inflammation, disease- and treatment-related damage as well as peculiar lupus features can act as independent risk factors for CVD and atherosclerosis. This study was designed to evaluate the cardiovascular affection in Egyptian patients with systemic lupus erythematosus and its relation to selected factors. Our study included 60 SLE patients (Group I), in addition to 30 apparently healthy individuals -age and sex matched- representing the control group (Group II). SLE patients were classified according to the presence of echocardiographic abnormalities into Group I-a (39 patients, present), Group I-b (21 patients, absent), and according to the presence of carotid abnormalities (increased intima-media thickness and presence of plaques) into Group I-c (8 patients, present), Group I-d (52 patients, absent). All patients were subjected to the following: full history taking including cardiovascular risk factors, and thorough clinical examination. Assessment of SLE activity according to SLE Disease Activity Index (SLEDAI) and the cumulative organ damage using the Systemic Lupus International Collaborating Clinics/ American College of Rheumatology Damage Index (SLICC/ACR). Full laboratory assessment was done including: complete blood count (CBC), erythrocyte sedimentation rate (ESR), high sensitive CRP, serum creatinine, complete urine analysis, 24 hour urinary protein assay, lipid profile (cholesterol, triglycerides, LDL, HDL), fasting blood sugar (FBS), anti ds-DNA antibodies, anticardiolipin antibodies, C3 and C4. Transthoracic echocardiography and carotid duplex were done for all patients and control subjects. In the present study, the prevalence of cardiovascular abnormalities among the Egyptian patients with SLE was found to be higher than their age and sex matched control subjects. In the current study, we demonstrated a variety of cardiovascular abnormalities among SLE patients including atherosclerotic vascular involvement in the form of increased carotid intimal medial thickness and carotid plaques and cardiac abnormalities including pericardial involvement in the form of pericardial effusion, myocardial involvement in the form of LV hypertrophy, LV diastolic dysfunction, myocarditis, and RWMA, endocardial involvement in the form of valvular affection, in addition to elevated pulmonary artery pressure. In the present study, SLE patients with carotid abnormalities had significantly higher (age, BMI, triglycerides level, fasting blood sugar, steroid duration of treatment and cumulative steroid dose), and lower C3 level. In the current study, SLE duration was found to be positively correlated to cardiovascular complications after applying the logistic regression model.