Endothelial function in systemic lupus erythematosus: relationship to disease activity, cardiovascular risk factors, corticosteroid therapy, and coronary calcification.

OBJECTIVES

Endothelial dysfunction is frequently present in patients with systemic lupus erythematosus and may increase their risk of premature coronary artery disease. In this pilot study we have characterized the relationship between endothelial function, measures of disease activity, and cardiovascular risk factors in patients with lupus.

METHODS

Clinical characteristics and cardiovascular risk factors were evaluated in 20 patients with lupus. Flow-mediated dilation of the brachial artery was measured using high resolution ultrasound and the presence or absence of coronary calcification determined by electron-beam computed tomography. The relationship between these variables and flow-mediated dilation was determined using Spearman correlation coefficients (RHO) and Mann Whitney-Wilcoxon tests.

RESULTS

Twenty patients (17 female) median age (interquartile range) 42.5 (32.0-47.5) years were studied. The median flow-mediated vasodilation was 3.6% (1.7%-7.7%). In patients with coronary calcification (n = 6), flow-mediated dilation was 2.1% (-0.42%-3.6%) compared with 4.0% (3.5%-8.3%) in those without (p = 0.12). There was no significant relationship between flow-mediated dilation and markers of disease activity, duration of disease, and cardiovascular risk factors. Lower flow-mediated dilation was associated with duration of corticosteroid therapy (RHO = -0.44, p = 0.05).

CONCLUSIONS

In these preliminary results, endothelial dysfunction is associated with long-term exposure to corticosteroids.