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Excess atherosclerosis in systemic lupus erythematosus,-A matter of renal involvement: Case control study of 281 SLE patients and 281 individually matched population controls.

Abstract Systemic lupus erythematosus (SLE), is a heterogeneous disease which predominantly affects young females (90%). SLE is associated with a shorter life expectancy than in the general population. Standardized mortality ratios (SMR) of 2.4 have been reported, which is comparable to diabetes. In modern societies cardiovascular disease (CVD) is the major cause of premature mortality. Accelerated atherosclerosis is generally assumed to be the underlying cause for SLE related CVD. However, previous studies diverge regarding whether atherosclerosis is more common in SLE than in controls. With this in mind and based on own clinical experience we hypothesized that accelerated atherosclerosis is not a general feature of SLE, but prevails in SLE subgroups.
PMID
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PMID- 28414714
OWN - NLM
STAT- In-Process
DA  - 20170417
LR  - 20170417
IS  - 1932-6203 (Electronic)
IS  - 1932-6203 (Linking)
VI  - 12
IP  - 4
DP  - 2017
TI  - Excess atherosclerosis in systemic lupus erythematosus,-A matter of renal
      involvement: Case control study of 281 SLE patients and 281 individually matched 
      population controls.
PG  - e0174572
LID - 10.1371/journal.pone.0174572 [doi]
AB  - BACKGROUND: Systemic lupus erythematosus (SLE), is a heterogeneous disease which 
      predominantly affects young females (90%). SLE is associated with a shorter life 
      expectancy than in the general population. Standardized mortality ratios (SMR) of
      2.4 have been reported, which is comparable to diabetes. In modern societies
      cardiovascular disease (CVD) is the major cause of premature mortality.
      Accelerated atherosclerosis is generally assumed to be the underlying cause for
      SLE related CVD. However, previous studies diverge regarding whether
      atherosclerosis is more common in SLE than in controls. With this in mind and
      based on own clinical experience we hypothesized that accelerated atherosclerosis
      is not a general feature of SLE, but prevails in SLE subgroups. METHODS: 281 SLE 
      patients and 281 individually age and sex matched population controls, were
      investigated clinically. Fasting blood samples and risk factor data were
      collected. All participants were subject to B-mode ultrasonography of the carotid
      arteries. Carotid plaque occurrence and mean intima media thickness (mIMT) were
      recorded. Two SLE subgroups previously described to be at high CVD risk; 1)
      patients with nephritis and 2) patients with anti-phospholipid antibodies (aPL), 
      and one subgroup reported to be at comparatively lower CVD risk; patients
      positive for Sjogren s syndrome antigens A/B (SSA/SSB) antibodies were analyzed
      separately in comparison with their respective matched controls. RESULTS: Median 
      age was 49 (IQR 36-59) years, 93% were females. Manifest CVD; ischemic heart,
      cerebro- and peripheral vascular disease, prevailed in patients (12% vs. 1%,
      p<0.0001). Overall plaque prevalence did not differ (20% vs. 16%), but patients
      had slightly higher mIMT than controls (0.56 vs. 0.53 mm, p<0.0033). After age
      adjustment plaques, but not mIMT, remained associated with previous CVD events.
      Therefore we focused further analyses on plaques, a more robust measure of
      atherosclerosis. Patients with nephritis (40%), but neither aPL (25%) nor SSA/SSB
      (40%) positive patients, had more plaques than their respective controls (23% vs.
      11%, p = 0.008). Notably, patients with nephritis were younger than other SLE
      patients (45 vs.49 years, p = 0.02). To overcome the confounding effect of age we
      performed an age-matched nested case-control analysis, which demonstrated that
      patients with nephritis had twice as often plaques (23%) as both non-nephritis
      patients (11%, p = 0.038) and controls (12%, p = 0.035). CONCLUSIONS: In SLE
      excess carotid plaques are essentially confined to the SLE subgroup with
      nephritis. This subgroup had plaques twice as often as age-matched non-nephritis 
      SLE patients and population controls. Non-nephritis SLE patients, including the
      aPL positive subgroup, which has a high CVD risk, had similar prevalence of
      plaques as controls. To prevent later CVD events, this novel observation calls
      for risk factor screening and initiation of anti-atherosclerotic treatment
      selectively in SLE nephritis patients. Preferably at nephritis onset, which is
      often at a young age. In a general perspective this study demonstrates the
      importance to perform careful clinical subgroup analyses when investigating
      heterogeneous, hitherto not clearly defined, conditions like SLE.
FAU - Gustafsson, Johanna T
AU  - Gustafsson JT
AD  - Unit of Rheumatology, Department of Medicine, Solna, Karolinska Institutet,
      Karolinska University Hospital, Stockholm, Sweden.
FAU - Herlitz Lindberg, Marie
AU  - Herlitz Lindberg M
AD  - Department of Clinical Physiology, Sodersjukhuset, Karolinska Institutet,
      Stockholm, Sweden.
FAU - Gunnarsson, Iva
AU  - Gunnarsson I
AD  - Unit of Rheumatology, Department of Medicine, Solna, Karolinska Institutet,
      Karolinska University Hospital, Stockholm, Sweden.
FAU - Pettersson, Susanne
AU  - Pettersson S
AD  - Unit of Rheumatology, Department of Medicine, Solna, Karolinska Institutet,
      Karolinska University Hospital, Stockholm, Sweden.
FAU - Elvin, Kerstin
AU  - Elvin K
AD  - Unit of Clinical Immunology, Department of Clinical Immunology and Transfusion
      Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm,
      Sweden.
FAU - Ohrvik, John
AU  - Ohrvik J
AD  - Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
FAU - Larsson, Anders
AU  - Larsson A
AD  - Department of Medical Sciences, Clinical Chemistry, Uppsala University, Uppsala, 
      Sweden.
FAU - Jensen-Urstad, Kerstin
AU  - Jensen-Urstad K
AD  - Department of Clinical Physiology, Sodersjukhuset, Karolinska Institutet,
      Stockholm, Sweden.
FAU - Svenungsson, Elisabet
AU  - Svenungsson E
AUID- ORCID: http://orcid.org/0000-0003-3396-3244
AD  - Unit of Rheumatology, Department of Medicine, Solna, Karolinska Institutet,
      Karolinska University Hospital, Stockholm, Sweden.
LA  - eng
PT  - Journal Article
DEP - 20170417
PL  - United States
TA  - PLoS One
JT  - PloS one
JID - 101285081
EDAT- 2017/04/18 06:00
MHDA- 2017/04/18 06:00
CRDT- 2017/04/18 06:00
PHST- 2016/10/24 [received]
PHST- 2017/03/11 [accepted]
AID - 10.1371/journal.pone.0174572 [doi]
AID - PONE-D-16-42297 [pii]
PST - epublish
SO  - PLoS One. 2017 Apr 17;12(4):e0174572. doi: 10.1371/journal.pone.0174572.
      eCollection 2017.

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