Assessment of vascular stiffness using different modalities in patients with systemic lupus erythematosus: a case control study

Abstract

Background: Cardiovascular disease is a major cause of morbidity and mortality in systemic lupus erythematosus (SLE) patients. Accurate risk stratification would require a simple, non-invasive index integrating all traditional and emerging risk factors. Vascular stiffness fulfills these requirements and has better predictive value for cardiovascular events than traditional risk factors in hypertensives and patients with coronary artery disease. Our aim was to determine whether arterial stiffness is increased in SLE patients compared to healthy controls and to correlate the arterial stiffness in SLE patients with cardiovascular risk factors, namely, hypertension and diabetes mellitus. Results: This study included 50 SLE patients and 50 age- and gender-matched healthy individuals. SLE patients had higher median aortic stiffness index (SI) and lower strain and distensibility, compared to controls (p value for all < 0.001). SLE patients had significantly impaired flow-mediated dilation (FMD) compared to controls: the median (range) in SLE patients was 8.82 (2.5–21.87), compared to 19 (12–37.5) in controls (z = − 7.695, p ˂ 0.001). Regarding quality arterial stiffness (QAS) parameters, SLE patients had significantly lower median carotid distension, distensibility coefficient, and compliance coefficient, with higher median carotid SI, carotid pulse wave velocity (PWV), and augmentation index (AI), compared to controls (p value for all ≤ 0.001). SLE patients had a higher median cf-PWV 6.5 m/s (4.8–11.8), compared to a median of 4.6 m/s (3.8–6.9) in controls (z = − 8.193, p ˂ 0.001). Linear regression analysis to adjust for hypertension and diabetes mellitus yielded a statistically significant difference between both groups for all of the above parameters (p = 0.014 for maximum carotid intima media thickness (IMT) and < 0.001 for remaining parameters), with the exception of the maximum carotid augmentation index (p = 0.184). Conclusion: SLE patients have significantly increased arterial stiffness and impaired FMD compared to healthy controls. This is true even after adjusting for hypertension and diabetes mellitus, highlighting the fact that SLE could be an independent cardiovascular risk factor. These findings emphasize the need for early management of SLE together with aggressive risk factor modification.