Increased prevalence of vulnerable atherosclerotic plaques and low levels of natural IgM antibodies against phosphorylcholine in patients with systemic lupus erythematosusReportar como inadecuado

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Arthritis Research and Therapy

, 12:R214

First Online: 23 November 2010Received: 17 July 2010Revised: 26 September 2010Accepted: 23 November 2010


IntroductionThe risk of cardiovascular disease CVD and atherosclerosis is reported to be increased in systemic lupus erythematosus SLE. We recently reported a negative association between natural IgM-antibodies against phosphorylcholine anti-PC in the general population, high anti-PC levels leading to decreased atherosclerosis development and low levels to increased risk of CVD. Potential mechanisms include anti-inflammatory properties and inhibition of uptake of oxidized low density lipoprotein LDL in macrophages. The objective herein was to study atherosclerosis in SLE in detail and in relation to traditional and non-traditional risk factors.

MethodsA total of 114 patients with SLE were compared with 122 age- and sex-matched population-based controls. Common carotid intima-media thickness IMT, calculated intima-media area cIMa and plaque occurrence were determined by B-mode ultrasound as a surrogate measure of atherosclerosis. Plaques were graded according to echogenicity and grouped as 1 to 4, with 1 being echoluscent, and considered most vulnerable. Anti-PC was studied by ELISA.

ResultsHypertension, triglycerides and insulin resistance determined by homeostasis model assessment of insulin resistance and C-reactive protein CRP were increased in SLE P < 0.01 while smoking, LDL, high density lipoprotein HDL did not differ between groups. Low levels of anti-PC IgM lowest tertile were more common in SLE patients than in controls P = 0.0022. IMT and cIMa did not differ significantly between groups. However, plaques were more often found in SLE patients P = 0.029. Age, LDL and IgM anti-PC lowest tertile were independently associated with plaque occurrence in SLE. Further, in the left carotid arteries echoluscent plaques grade 1 were more prevalent in SLE as compared to controls P < 0.016.

ConclusionsPlaque occurrence in the carotid arteries is increased in SLE and is independently associated with age, LDL and low anti-PC levels. Vulnerable plaques were more common in SLE. Anti-PC could be a novel risk marker also with a therapeutic potential in SLE.

AbbreviationsACSacute coronary syndrome

Anti-PCantibodies against PC

aPLanti-phospholipid antibodies

BMIbody mass index

cIMacalculated intima-media area

CABGcoronary artery by-pass graft

CCAcommon carotid artery

CIconfidence interval

CRPC-reactive protein

CVDcardiovascular disease

HChip circumference

HDLhigh density lipoprotein


IMTintima-media thickness

IQRinterquartile range

LDLlow density lipoprotein

oxLDLoxidized low density lipoprotein

PAFplatelet activating factor


SLEsystemic lupus erythematosus

WCwaist circumference.

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Autor: Cristina Anania - Thomas Gustafsson - Xiang Hua - Jun Su - Max Vikström - Ulf de Faire - Mikael Heimbürger - Tomas Joges


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