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TNF-: a link between hypertriglyceridaemia and inflammation in SLE patients with cardiovascular disease

Department of Medicine, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden, elisabet.svenungsson{at}medks.ki.se

G-Z Fei

Department of Medicine, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden

K Jensen-Urstad

Department of Clinical Physiology, Karolinska Institutet, Stockholm, Sweden

U de Faire

Institute of Environmental Medicine, Cardiovascular Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden

A Hamsten

Department of Medicine, Atherosclerosis Research Unit, Karolinska Institutet, Stockholm, Sweden

J Frostegård

Department of Medicine, Rheumatology Unit, Karolinska Institutet, Stockholm, Sweden

Patients with systemic lupus erythematosus (SLE) are at high risk of cardiovascular disease (CVD). Tumour necrosisfactor-a (TNF-) has been implicatedin the pathophysiologicalprocessesof both SLE and CVD. This study focuses on the role of TNF- and its soluble receptors in SLE-related CVD. In summary, 26 women (52 + 8.2 years) with SLE and a history of CVD (SLE cases)were compared with 26 age-matched women with SLE and no clinical manifestations of CVD (SLE controls) and 26 age-matched population-based control women (population controls). Plasma concentrations of circulating TNF-, TNF- receptor 1 (sTNFR1) and TNF- receptor 2 (sTNFR2) were determined by ELISA. TNF-, sTNFR1 and sTNFR2 were raised in SLE cases as compared to SLE controls (P = 0.009; P = 0.001; P = 0.001, respectively), and SLE controls had higher levels than population controls (P = 0.001; P = 0.02; P = 0.001, respectively). Exclusively in the SLE case group there was a striking positivecorrelationbetweenTNF- and plasma triglycerides(r = 0.57, P < 0.002), VLDL triglycerides (r = 0.54, P = 0.004) and VLDL cholesterol (r = 0.58, P = 0.002). Furthermore, TNF- correlated with the waist-hip ratio but not with estimated insulin resistance. TNF- may thus be a major factor in SLE-related CVD acting both by contributing to hypertriglyceridaemia and by promoting atherosclerosis-relatedinflammation. sTNFR1 and sTNFR2 are strongly associated with CVD in SLE but their exact roles in disease development remain to be elucidated.

Key Words: atherosclerosis • lipoproteins • SLE • TNF receptor • TNF-

Lupus, Vol. 12, No. 6, 454-461 (2003)
DOI: 10.1191/0961203303lu412oa


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