Endothelial dysfunction in systemic autoimmune diseases

Abstract

Introduction: Systemic autoimmune diseases are characterized by inflammation, and this is hypothesized to be the driver fueling accelerated atherosclerosis observed in these diseases. Endothelial dysfunction is an early step in the formation of atherosclerotic lesions in patients with systemic autoimmune diseases and can be assess by non-invasive methods. Objective of the study: To evaluate endothelial dysfunction in patients with rheumatic diseases and it association with disease activity and inflammatory variables. Materials and methods: The prospective study included 16 patients with rheumatic diseases hospitalized in Rheumatology department in the Institute of Cardiology. Patients were examined according to questionnaire that included general data, evaluation of traditional cardiovascular risk (CV) factors, diseases activity index and markers of endothelial dysfunction (low-density lipoprotein (LDL), circulating levels of C-reactive protein (CRP), ankle-brachial index, intima-media thickness of carotid artery (IMT) and flow-mediated dilation (FMD). Results: The study group was represented by 16 patients: 5 with LES, 3-systemic scleroderma, 3-rheumatoid arthritis, 3-vasculitis and 1 with myositis. The average age was 45,4 ± 0.05 (22-73 year old), the women: men ratio being 3:1 with the predominance of women. The disease duration was 11.8 year (2–36 year old) and high disease activity was attested in 9 (60%) cases. The distribution of CV risk factors relives: hypertension in 9 (60%), obesity – 2 (13,3%), family history – 6 (40%), smoking and diabetes mellitus in 1 (6.6%) cases. Analyzes of endothelial dysfunction markers show increase level of LDL in 11 (73,3%), abnormal CRP level in 7 (46.6%) patients. Ankle-brachial index was abnormal in 6 (40%). The IMT of carotid artery was increased in 5 (33,3%), and atherosclerotic plaque was identified in 5 (33,3%) patients, while the FMD of the brachial artery was decreased only in 2 (1,26%) patients.Conclusion: Endothelial dysfunction is common in patients with systemic autoimmune diseases and is Associated with traditional cardiovascular risk factors, more significant are, level of LDL in 11 (73,3%) and hypertension in 9 (60%). Among non-traditional risk factors we note the role CRP level in 7 (46.6%) and abnormality of ankle-brachial index - in 6 (40%) that correlates with the duration and activity of disease.