Aterosclerose no Lúpus Eritematoso Sistêmico: fatores de risco para doença arterial coronariana e alterações ateroscleróticas ultra-sonográficas em carótidas

• Ano de defesa: 2007
• Autor(a) principal: Rosa Weiss Telles
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de Minas Gerais; UFMG
• Palavras-chave em Português: Aterosclerose; Doença cardiovascular manifesta; Ultra-sonografia de carótidas; Fatores de risco para doença arterial coronariana; Lúpus eritematoso sistêmico; Aterosclerose DeCs; Arteriosclerose coranária; Doenças cardiovasculares; Clínica Médica; Vasos coronários; Fatores de risco; Doenças das artérias carótidas; Lupus eritematoso sistêmico
• Link de acesso: http://hdl.handle.net/1843/ECJS-7ENMQU

Introduction: Patients with systemic lupus erythematosus (SLE) have a high frequency of cardiovascular disease and subclinic atherosclerosis. The pathogenesis of atherosclerosis in SLE is not completely understood. SLE-related factors may be associated with traditional risk factors for coronary disease. Objective: To determine the frequency of cardiovascular disease and traditional risk factors in patients withSLE at Rheumatology Division of Hospital das Clínicas of the Federal University of Minas Gerais. To determine the frequency of carotid plaque and intima-media thickness (IMT) and to evaluate their association with risk factors for coronary artery disease and lupus-specific variables. Methods: This is an observational crosssectional study. Patients 18 years-old or older who met the American College of Rheumatology classification criteria for SLE were consecutively included. Data oncardiovascular disease, traditional risk factors e SLE-related factors were collected from an interview, physical examination and from the medical charts. Carotid plaque and IMT were identified and measured by ultrasonography. Results: 172 patients were evaluated. The mean age of the patients was 38.5 years (standard deviation: 11.2 years), 95.9% were female, and 64,5% non white. Cardiovascular disease was identified in 8 patients (4.7%), with 11 different diagnoses. Three patients had coronary insufficiency, three had stroke and five had peripheral arterial disease.Hypertension was the most frequent risk factor (48.8%), followed by dyslipidemia in 70 patients (40.7%) and hypertriglyceridemia in 51 patients (29.7%). Low density lipoprotein cholesterol (LDL-c) >100mg/dl was found in 77 patients (44.8%). Among 165 female patients, 67 (40.6%) had menopause, 43.3% of them with early menopause. The frequency of carotid plaque was 9.3%. The median IMT was 0.60 mm (interquatile range: 0.54-0.71 mm). Age, family history of prematurecoronary disease, LDL-c>100 mg/dl, hypertriglyceridemia, diabetes mellitus, hypertension, smoking, menopause, number of risk factors and Framingham risk score, age at diagnosis, duration of lupus, mucocutaneous manifestations, and duration of prednisone use were associated with focal plaque (p<0.005), univariate analysis. Diagnosis of nephritis, immunosuppressive therapy, intravenous methylprednisolone, and the higher average daily dose of prednisone over the followup period were associated with the absence of plaques, univariate analysis.Independent predictors of the presence of plaque were smoking (p=0.004), LDLc> 100 mg/dl (p=0.044), Framingham risk score (p=0.006) and absence of use of immunosuppressive drugs (p=0.032). There was an independent correlation between IMT and age (p<0.001) and duration of prednisone use (p=0,020).Conclusion: The patients studied had a low frequency of cardiovascular events. About 74% of patients had at least one traditional risk factor and hypertension was the most frequent riskfactor found. The presence of subclinical atherosclerosis has been associated with traditional risk factors as well as SLE-related factors, especially the absence of immunosuppressive therapy. The present study suggests that the levels of LDL-c should be kept under 100 mg/dl in lupus patients.