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Cardiac valvular abnormalities are frequent in systemic lupus erythematosus patients with manifest arterial disease

Cardiovascular Laboratory, Department of Medicine, Karolinska Institute at Karolinska Hospital, Stockholm, Sweden

E Svenungsson

Department of Rheumatology and Centre for Molecular Medicine, Karolinska Institute at Karolinska Hospital, Stockholm, Sweden

U de Faire

Cardiovascular Laboratory, Department of Medicine; Division of Cardiovascular Epidemiology, Institute of Environmental Medicine, Karolinska Institute at Karolinska Hospital, Stockholm, Sweden

A Silveira

Department of Cardiology and King Gustaf V Research Institute, Karolinska Institute at Karolinska Hospital, Stockholm, Sweden

J L Witztum

Department of Medicine, University of California, San Diego, CA, USA

A Hamsten

Department of Cardiology and King Gustaf V Research Institute, Karolinska Institute at Karolinska Hospital, Stockholm, Sweden

J Frostegard

Department of Rheumatology and Centre for Molecular Medicine, Karolinska Institute at Karolinska Hospital, Stockholm, Sweden

The objective of this study was to study cardiac valve morphology and function and ventricular function in systemic lupus erythematosus(SLE) patients with and without co-existingcardiovascular disease (CVD) and in populationcontrols.Twenty-six women (52 8.2 years) with SLE (SLE cases) and a history of CVD (angina pectoris, myocardial infarction, cerebral infarction or intermittent claudication) were compared with 26 age-matched women with SLE but without manifest CVD (SLE controls) and 26 age-matched control women (population controls). Echocardiography was performed to assess valvular abnormalities and manifestations of ischaemic heart disease. Thirteen of the 26 SLE cases but only one of the SLE controls and one of the population controls had cardiac valvularabnormalities.Three of the SLE cases had already undergonevalve replacement and another had significant aortic insufficiency; the other nine had thickening of mainly mitral leaflets without hemodynamic significance. Among SLE cases, patients with valvular abnormalities had higher homocysteine (P < 0.001) and triglyceride (P=0.02) concentrations than patients without valvular disease. In contrast atherosclerosis as determined by IMT, oxidized LDL as measured by the monoclonal antibody E06, autoantibodiesagainst epitopesof OxLDL (aOxLDL) or phospholipids (aPL), disease duration or activity, or acute phase reactants did not differ between SLE cases with or without valvular abnormalities.Valvular abnormalitieswere not more common in SLE cases with stroke as compared to those with myocardial infarction, angina or claudication. In conclusion, valvular abnormalities are strongly associated with CVD in SLE. Raised levels of homocysteine and triglycerides characterize patients with cardiac valve abnormalities.

Key Words: atherosclerosis • cardiac valve • echocardiography • systemic lupus erythematosus

Lupus, Vol. 11, No. 11, 744-752 (2002)
DOI: 10.1191/0961203302lu254oa


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