Intima-media thickness and phospholipase-A2 possible markers for atherosclerosis progression in patients with systemic lupus erithematous

Problemstellung: In systemic lupus erythematous (SLE), disease related factors and chronic activation of the immune system are implicated in vascular damage, inducing premature atherosclerosis. Intima-media thickness (IMT) is a non-invasiv marker of endothelial dysfunction, can be assessed by B-mode ultrasound and represents a safe, inexpensive, precise and reproducible measure. Phospholipase-A2 (PL-A2), an enzime higly expressed in atherosclerotic lesions is incresed in patients with SLE, related to disease activity.

Aim: to determine the importance of IMT in monitoring the early arterial wall alteration and its relation with PL-a2 as a marker of disease activity in SLE patients.

Methode: Methods: 45 SLE patients fulfiling ACR criteria, which take specific treatment, were divided in two groups: gr. I (27patients) consenting to take endothelial protection treatment (EPT), atorvastatin-20mg/d, perindopril-2mg/d, aspirin-100mg/d and gr. II (18 patients) without EPT. Patients evaluation included clinical examination, 12-leads ECG, effort treadmill test, carotid ultrasonography, echocardiography, routine laboratory tests, serological tests and determination of serum PL-A2 as marker of the inflammatory state. The follow-up period was 6 month.

Ergebnisse: Results: At admission in both groups intimal-media thickness of the common carotid artery was quite similar (0,10±0,04cm), atheroma plaques:gr. I-10p (37%), gr II-6p (33,3%), ischemic events (angina episodes/week, ECG change):grI-5p (14,7%), grII-3p (16,6%) and mean

PAF-AH activity 385,67±80,52. After 6 month there were registered differences between the groups regarding IMT (gr I-0,08±0,02cm gr II-0,12±0,04cm). serum PQAF-AH activity (gr I-280,30±40,50, gr II-364,69±60,5) and ischemic episodes (gr I-3,7%, gr II-11,11%). The percentage of the plaques was not significant changed (gr I-40%, gr II-33,6%).

Schlussfolgerung: Conclusions: SLE is associated with increased risk for atherosclerosis. Increased IMT seems to be correlated with PL-A2 levels and its progressions is related to disease activity. EPT reducing early atherosclerotic lesions may be considered as an associate therapy in SLE patients improving endothelial function and preventing cardiovascular events.