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CNAA / Theses / 2009 / May /

Particularities of cardiovascular pathology in systemic lupus erythematosus


Author: Mazur-Nicorici Lucia
Degree:doctor of medicine
Speciality: 14.00.06 - Cardiology and Rheumatology
Year:2009
Scientific adviser: Valeriu Revenco
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 29 May, 2009
Approved by NCAA on the 1 October, 2009

Abstract

Adobe PDF document0.81 Mb / in romanian

Keywords

systemic lupus erythematosus, risk factors, cardiovascular events, dyslipidemia, atherosclerosis

Summary

The study (main group) included 90 patients (80 females, 10 males) with mean age 37,87±12,1 diagnosed with systemic lupus erythematosus (SLE) according to criteria of American College of Rheumatology. Confirmed diagnosis of SLE, age between 15-50 years old, treatment with glucocorticosteroids, no statins administration served as inclusion criteria. Patients with hepatitis or other active autoimmune diseases, acute viral or bacterial infections, advanced renal failure were excluded from the study. The control group was composed of 35 persons selected from outpatient clinic.

Complex examine of patients has revealed cardiovascular pathology in more than a half of patients (65,5%), most frequent of them was pericarditis (50,0%), followed by arterial hypertension (33,3%), valvular regurgitation (32,2%), congestive heart failure (13,3%), arrhythmia (13,3%) and myocarditis (4,4%). Having analyzed the correlation between clinical presentation, disease activity, lesion index (LI) we found relationship between the activity of SLE and skin manifestations, and lack of relationship between LI and disease activity. Index of organ lesion was influenced mostly by clinical presentation of SLE and its treatment, especially by glucocorticosteroids, increasing simultaneously with initiation of major cardiovascular events.

We found that SLE patients in comparison with healthy people of the same age presented a fewer number of cardiovascular risk factors. Thus, obesity was found in 13,3 versus 37,1%, smoking – 26,6 versus 54,3%, hypercholesterolemia – 51, 1 versus 64,7%, while arterial hypertension was diagnosed in 33,3 versus 22,8% and hypertrigliceridemia - 26,6 versus 11.4% were more frequent in SLE patients.

Atherosclerotic cardiovascular pathology was confirmed in 21,1% of SLE patients, including 14,4% of ischemic heart disease (stable angina – 11,1% and myocardial infarction – 3,3%) and 6,6% of stroke. The presence of anti–phospholipid syndrome increases the incidence of cardiovascular pathology and subclinical atherosclerosis. More evident thickness of comlex intima-media and (or) the presence of atherom plaques was found in SLE patients aged less than 50 years old, what confirms early onset of atherosclerosis, in spite of the fact that the number of cardiovascular risk factors in such patients was fewer.

As the result of evaluation of the risk of major cardiovascular events in SLE patients according to SCORE diagram was found the contribution of the other factors which influence early onset of atherosclerosis in SLE patients such as disease activity, cumulative glucocorticosteroid dose, elevated level of hypersensitive CRP and the presence of secondary antiphospholipid syndrome.