Novel cardiovascular risk factors in premature coronary atherosclerosis associated with systemic lupus erythematosus.

Abstract

Several mediators of inflammation are associated with atherosclerotic cardiovascular disease in the general population, but their relationship to accelerated atherosclerosis associated with an inflammatory disease such as systemic lupus erythematosus (SLE) is not known. We compared concentrations of cytokines (TNF-alpha, IL-1alpha, and VEGF), inflammatory enzymes (MPO and MMP-9), acute-phase reactants (ESR, CRP, and SAA) and adhesion molecules (VCAM, ICAM, and E-selectin) in 109 patients with SLE and 78 controls. The relationship between inflammatory markers and coronary atherosclerosis detected as calcified plaque by electron beam CT was determined in patients with SLE. Concentrations of all markers of inflammation other than VCAM, MMP-9, and IL-1alpha were significantly higher in SLE. In multivariable analyses adjusting for Framingham risk score, cumulative corticosteroid dose, and diabetes, E-selectin (OR 1.90, 95% CI 1.08-3.33), VCAM (OR 1.99, 1.18-3.37), ICAM (OR 2.30, 1.13-4.7), and TNF-alpha (OR 2.36, 1.10-5.06) were significantly associated with the severity of coronary calcium. Concentrations of adhesion molecules and TNF-alpha are associated with coronary atherosclerosis in SLE independent of the Framingham risk score.