Frequency of Cardiovascular Risk Factors in Systemic Lupus Erythematosus: A Case-Control Study in a Department of Internal Medicine in Sub-Saharan Africa
Background: The morbidity and mortality of systemic lupus erythematosus are largely due to accelerated atherosclerosis. This is partly related to the high prevalence of traditional cardiovascular risk factors. The aim of our study was to determine the frequency of these factors in lupus patients compared to a control population in a department of internal medicine. Methods: We realized a case-control study in patients with systemic lupus erythematosus according to ACR criteria in 1997. Patients were matched by age and gender with controls subjects without autoimmune disease. We studied the frequency of traditional cardiovascular risk factors in both populations. The study was done in the department of internal medicine of Aristide Le Dantec teaching Hospital, in Senegal, during the period from August 2017 to December 2018. The statistical analysis was performed with SPSS 23.0 software and the level of significance was retained for a p-value < 0.05. Results: We recruited 100 subjects including 50 patients and 50 controls. The mean age was 33.5 ± 11.3 years in cases and 33.3 ± 11.3 years in controls. Dyslipidemia was significantly associated with systemic lupus erythematosus (p = 0.009). Levels of triglycerides (p < 0.001) and uricemia (p < 0.001) were significantly higher in patients. The level of HDL cholesterol (p = 0.028) was lower in cases. Thus, low HDL cholesterolemia (p = 0.001), hypertriglyceridemia (p < 0.001), and hyperuricemia (p = 0.043) were more common in the cases. Renal failure was associated with systemic lupus erythematosus (p < 0.001). Difference in LDL-cholesterol (p = 0.103), hypertension (p = 1) and metabolic syndrome (p = 1) between cases and controls was not significant. Obesity and overweight were predominant in controls (p = 0.028). Conclusion: Traditional cardiovascular risk factors including dyslipidemia and hyperuricemia were more common in patients. Similarly, renal failure was associated with lupus.
References
[1]
Tazi Mezalek, Z., Harmouche, H., Ammouri, W., Maamar, M., et al. (2014) Atherosclerosis in Systemic Lupus Erythematosus. La Presse Médicale, 43, 1034-1047. https://doi.org/10.1016/j.lpm.2014.01.021
[2]
Liu, Y. and Kaplan, M.J. (2018) Cardiovascular Disease in Systemic Lupus Erythematosus: An Update. Current Opinion in Rheumatology, 30, 441-448. https://doi.org/10.1097/BOR.0000000000000528
[3]
Croca, S. and Rahman, A. (2017) Atherosclerosis in Systemic Lupus Erythematosus. Best Practice & Research Clinical Rheumatology, 31, 364-372. https://doi.org/10.1016/j.berh.2017.09.012
[4]
Hochberg, M.C. (1997) Updating the American College of Rheumatology Revised Criteria for the Classification of Systemic Lupus Erythematosus. Arthritis & Rheumatology, 40, 1725. https://doi.org/10.1002/art.1780400928
[5]
Utilisation et interprétation de l’anthropométrie (1995) Rapport d’un Comité d’experts. Organisation mondiale de la Santé, Genève. OMS, Série de Rapports techniques. No 854:367.
[6]
Alberti, G. and Zimmet, P. (2006) The IDF Consensus Worldwide Definition of the Metabolic Syndrome. International Diabetes Federation, Bruxelles.
[7]
Alenghata, F.J. (2016) The Prevalence of Atherosclerosis in Those with Inflammatory Connective Tissue Disease by Race, Age, and Traditional Risk Factors. Scientific Reports, 6, Article No. 20303. https://doi.org/10.1038/srep20303
[8]
Borchers, A.T., Naguwa, S.M., Shoenfeld, Y. and Gershwin, M.E. (2010) The Geoepidemiology of Systemic Lupus Erythematosus. Autoimmunity Reviews, 9, A277-A287. https://doi.org/10.1016/j.autrev.2009.12.008
[9]
Moya, F.B., Pineda, G.L.F. and García, M. (2016) Impact of Chronic Glucocorticoid Treatment on Cardiovascular Risk Profile in Patients with Systemic Lupus Erythematosus. Journal of Clinical Rheumatology, 22, 8-12. https://doi.org/10.1097/RHU.0000000000000335
[10]
Nasonov, E.L., Popkova, T.V. and Novikova, D.S. (2016) Cardiovascular Disease in Rheumatic Diseases. Ter Arkh, 88, 4-12. https://doi.org/10.17116/terarkh20168854-12
[11]
Serraj, K., Mecili, M., Zahi, I., Jeandidier, N. and Andres, E. (2011) Connectivites et risque cardiovasculaire: État des lieux. Revue Médecine Thérapeutique, 17, 11-22.
[12]
Leeuw, K., Freire, B., Smit, J., et al. (2006) Intima Media Thickness Is Increased in SLE. Lupus, 15, 675-682. https://doi.org/10.1177/0961203306069972
[13]
Park, J.K., Kim, J.Y., Moon, J.Y., Ahn, E.T., et al. (2016) Altered Lipoproteins in Patients with Systemic Lupus Erythematosus Are, Associated with Augmented Oxidative Stress: A Potential Role in Atherosclerosis. Arthritis Research & Therapy, 18, 306. https://doi.org/10.1186/s13075-016-1204-x
[14]
Olusi, S.O. and Sunila, G. (2011) Prevalence of LDL Atherogenic Phenotype in Patients with Systemic Lupus Erythematosus. Vascular Health and Risk Management, 7, 75-80. https://doi.org/10.2147/VHRM.S17015
[15]
Harzallah, A., Hajji, M., Kaaroud, H., Hamida, B.F. and Abdallah, B.T. (2007) Facteurs de risque cardio-vasculaires au cours du lupus systémique. Pan African Medical Journal, 22, 367. https://doi.org/10.11604/pamj.2015.22.367.7611
[16]
Ahmad, Y., Shelmerdine, J., Bodill, H., Lunt, M., et al. (2007) Subclinical Atherosclerosis in Systemic Lupus Erythematosus SLE: The Relative Contribution of Classic Risk Factors and the Lupus Phenotype. Rheumatology, 46, 983-988. https://doi.org/10.1093/rheumatology/kem002
[17]
Lertratanakul, A., Wu, P., Myer, R.D., Kondos, J., et al. (2014) Risk Factors in the Progression of Subclinical Atherosclerosis in Women with Systemic Lupus Erythematosus. Arthritis Care & Research (Hoboken), 66, 1177-1185. https://doi.org/10.1002/acr.22271
[18]
Asanuma, Y., Oeser, A., Shintani, A.K., Turner, E., et al. (2003) Premature Coronary-Artery Atherosclerosis in Systemic Lupus Erythematosus. The New England Journal of Medicine, 349, 2407-2415. https://doi.org/10.1056/NEJMoa035611
[19]
Gustafsson, J.T., Lindberg, M.H., Gunnarsson, I., Pettersson, S., et al. (2017) Excess Atherosclerosis in Systemic Lupus Erythematosus: A Matter of Renal Involvement. PLoS ONE, 17, e0174572.
[20]
Borba, E.F. and Bonfa, E. (2001) Longterm Beneficial Effect of Chloroquine Diphosphate on Lipoprotein Profile in Lupus Patients with and without Steroid Therapy. Journal of Rheumatology, 28, 780-785.
[21]
Volkmann, E.R., Grossman, J.M., Sahakian, L.J., Skaggs, B.J., et al. (2010) Low Physical Activity Is Associated with Proinflammatory High Density Lipoprotein and Increased Subclinical Atherosclerosis in Women with Systemic Lupus Erythematosus. Arthritis Care & Research (Hoboken), 62, 258-265. https://doi.org/10.1002/acr.20076
[22]
Machado, D., Sarni, R.O.S., Abat, T.T., Silva, S.G.L., et al. (2017) Lipid Profile among Girls with Systemic Lupus Erythematosus. Rheumatology International, 37, 43-48. https://doi.org/10.1007/s00296-015-3393-z
[23]
Allard, A., Bardin, T., Meyer, O., et al. (2009) Hyperuricémie et risque cardiovasculaire. In: Kahn, M.F. and Bardin, T., Eds., L’actualité rhumatologique 2009, Elsevier, Paris, Abstract.
[24]
Cottiero, R.A., Madaio, M.P. and Levey, A.S. (1995) Glomerular Filtration Rate and Urinary Albumin Excretion Rate in Systemic Lupus Erythematosus. Nephron, 69, 140-146. https://doi.org/10.1159/000188429
