Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Prevalence of Flow Mediated Dilatation and Its Association with Framingham Risk Score in a Population of Women with Systemic Lupus Erythematosus.

Peeva4,  Valentina, Harvey3,  Paula, Su3,  Jiandong, Aghdassi3,  Ellie, Al-Dhanhani3,  Ali, Morrison3,  Stacey, Pineau2,  Christian

London, ON, Canada
Montreal, QC, Canada
Toronto, ON, Canada
University Health Network, Toronto Western Hospital, Toronto, ON, Canada

Background:

Patients with SLE have an increased risk for cardiovascular disease (CVD).Traditional assessment of CVD risk profile is measured using Framingham Risk Score (FRS), but this may not capture all CVD risk factors in patients with SLE. An alternative tool to assess CVD risk is the Flow Mediated Dilation (FMD)

Objective:

1) To perform CVD risk assessment using FRS and endothelial flow mediated dilatation (FMD) using high-resolution brachial artery ultrasound and 2) To determine association between endothelial function and FRS in women with SLE.

Methods:

Our cohort consists of 173 females, >=4 ACR criteria for SLE in whom the FRS and FMD were assessed as part of a study. Ten-year FRS was calculated on the basis of patients: age, smoking, systolic blood pressure (SBP), total cholesterol (TC) and HDL-cholesterol. Smoking, family history, SBP>130mmHg, serum TC>5.5 mmol/l and HDL<1.3mmol/l, were considered as risk factors for CVD. Normal FMD was defined as a 6% to 15% increase in the post-cuff inflation diameter change of the artery. Abnormal FMD was defined as <6% increase in the post-cuff inflation diameter. Associations between FMD and FRS were assessed using linear regression analysis.

Results:

The mean (SD) age was 43.6 (12.7) years, SLE duration was 8.9 (2.4, 18.6) and 23% (n=77) were smokers. The mean SBP was at 121.9 mmHg (14.7) and. 22.5% had elevated SBP. The mean (SD) serum profile were as follows; triglycerides: 1.2 (0.6) mmol/l, total cholesterol: 4.7 (1.1) mmol/l, LDL-cholesterol 2.6 (0.8) mmol/L, HDL-cholesterol: 1.7 (0.6) mmol/L, TC/HDL ratio: 3.0(1.0), homocysteine:10.7 (4.3) mmol/L and CRP: 3.2 (6.2) mg/l. Abnormal serum levels were seen in 14.2 % for TG, 21.2% for TC, 50.8% for LDL, 18.4% for HDL,16.7% for homocysteine and 62.7% for CRP. The distribution of total CVD risk factors were as follows: 31% had 1, 44 % had 2 – 4 and 25 % had >=5 risk factors. 44% (n=76) were at low risk (FRS=1–5 %), 24% (n=42) intermediate risk (FRS=6–10%), 20% (n=35) at high risk (FRS=11–20%) and 12% (n=20) at very high risk (FRS> 20%). For each FRS risk the equivalent % FMD change and proportion of patients with abnormal FMD are reported in Table 1. Adjusted linear regression showed that for each increase of 1% in FRS one observes an average 0.24% decrease in FMD cuff change.

Table 1. FRS, FMD cuff change (%) and proportion of abnormal FMD.

Framingham Risk ScoreMean %FMD +/- SD (cuff change)No of abnormal FMD/No of patients
<5%10.1 +/- 8.230/76 (40%)
6–10%9.4 +/- 6.714/42 (33%)
11–20%8.8 +/- 8.917/35 (49%)
>20%7.0 +/- 5.710/20 (50%)

Conclusion:

FRS explains only a subgroup of patients with abnormal FMD, with approximately 40% of SLE patients with low FRS having abnormal FMD. Assessment of FMD in SLE may identify a subgroup of patients with endothelial dysfunction not identified by FRS. Following these patients prospectively may help to determine their actual CVS risk.

To cite this abstract, please use the following information:
Peeva, Valentina, Harvey, Paula, Su, Jiandong, Aghdassi, Ellie, Al-Dhanhani, Ali, Morrison, Stacey, et al; Prevalence of Flow Mediated Dilatation and Its Association with Framingham Risk Score in a Population of Women with Systemic Lupus Erythematosus. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2120
DOI: 10.1002/art.29884

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