ROLE OF INFLAMMATION MARKERS IN DEVELOPMENT OF ATHEROSCLEROSIS AND ITS COMPICATIONS IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

Abstract

Cardiovascular events caused by early development and rapid progression of atherosclerotic vascular disease are the main reason behind early lethality among patients with systemic lupus erythematosus (SLE). The rapid development of atherosclerosis in patients with this disease is related to the inflammatory nature of SLE and associated with different inflammatory mediators.Objective. To specify the role of markers and inflammatory mediators (soluble CD40L (sCD40L), soluble tumor necrosis factor α receptors (sTNFα), and neopterin) in the development of atherosclerosis in SLE patients. Materials and Methods. 227 patients (156 females and 71 males) with SLE were examined; median age was 35.6±0.7 years; mean duration of disease was 132.9±7.7 months. The presence of the conventional risk factors (RF) of cardiovascular diseases was determined in SLE patients and control group individuals. Thickening of the intima-media complex and presence of atherosclerotic plaques are signs of atherosclerotic lesion of vessels. The control group consisted of 116 individuals having no rheumatic diseases. Serum concentrations of sCD40L, sTNFα, and neopterin were determined in 187, 193, and 155 SLE patients, respectively, and in 20 control group individuals.Results. sCD40L, sTNFα, and neopterin levels in SLE patients were higher than those in the control group (p<0.05). sCD40L concentration was associated with age, presence of conventional RFs, cholesterol (CS) level, low-density lipoprotein CS, SLE-related factors (SLEDAI-2K score, duration of disease, subclinical manifestations of atherosclerosis, and presence of ischemic heart disease (p>0.05 in all cases)). A relationship was found between sTNFα concentration and arterial hypertension, systolic and diastolic arterial blood pressure levels, concentrations of triglycerides (TG), high-density lipoprotein CS (HDL CS), apolipoprotein A1, factors associated with SLE (duration of disease, chronic kidney disease, SLEDAI-2K score, and lesion index (p<0.05 in all cases)). No reliable association was detected between the sTNFα and manifestations (clinical and subclinical) of atherosclerosis. A reliable difference was revealed between the sTNFα levels depending on gender: the average sTNFα level in males and females was 5.2±1.1 and 4.2±0.3 ng/ml, respectively (p=0.027). The neopterin level correlated with concentrations of TG, LDL CS, atherogenity index, clinical manifestations of atherosclerosis, and SLE-related factors: SLEDAI-2K score and presence of chronic kidney disease (p<0.05 in all cases).Conclusions: sCD40L is the key biological marker of atherosclerotic lesions in blood vessels; the increase in its concentration can be used to predict the risk of cardiovascular complications in SLE patients. The results allow one to consider neopterin both as an immunological indicator of autoimmune pathology and as a predictor of atherosclerotic lesions in blood vessels and related cardiovascular catastrophes. The increase in sTNFα can be used as a laboratory marker of the activity of SLE and atherosclerotic vascular disease.

Keywords

• systemic lupus erythematosus
• atherosclerosis
• tumor necrosis factor α
• neopterin
• cd40 ligand