Lupus Linked to Premature Blood Vessel Plaques

Lupus would appear to be a risk factor for the development of premature blood vessel plaques associated with atherosclerosis, sometimes referred to as “hardening of the arteries,” according to two reports in The New England Journal of Medicine. However, treatment with immune-suppressing drugs may help reduce this risk.

Lupus would appear to be a risk factor for the development of premature blood vessel plaques associated with atherosclerosis, sometimes referred to as “hardening of the arteries,” according to two reports in The New England Journal of Medicine. However, treatment with immune-suppressing drugs may help reduce this risk.Conventional wisdom holds that premature plaques develop from conventional risk factors that are worsened by treatment with steroids, Dr. Mary J. Roman and associates note in the first paper. Only recently has atherosclerosis been attributed to lupus itself. Roman, of the Weill Medical College of Cornell University in New York, and her team conducted a study that included 197 patients with lupus and 197 similar “control” subjects without lupus. Ultrasound was used to test for plaques in a major neck artery. Overall, the risk of atherosclerosis was 2.4-times higher in lupus patients compared with controls. The discrepancy was even larger in younger age groups: among people age 40 and younger, 13 percent of lupus patients had plaques compared with only 2 percent of controls. Risk factors for plaques in the patient group included a long history of lupus and not being treated with immune-suppressing drugs. Thus, the authors conclude, “more vigorous therapy might decrease the likelihood and burden of atherosclerosis in patients with lupus and, perhaps, in those with other chronic inflammatory diseases.” Only using immune-suppressing drugs when lupus gets particularly bad may not be adequate enough to prevent plaques, they add. In the second article, Dr. Yu Asanuma, at Vanderbilt University School of Medicine in Nashville, and colleagues used special CT scans to identify plaques in 65 patients with lupus and 69 control subjects. Unlike the first study, the researchers looked for plaques in the coronary arteries, the blood vessels that feed the heart. Plaques were present in 20 patients and 6 controls. After accounting for the effects of smoking, high blood pressure and other factors, lupus patients were nearly 10 times more likely to have plaques than were controls. Both teams also found that risk factors that predict the development of plaques in healthy subjects did not predict them in patients with lupus. (Source: The New England Journal of Medicine, Reuters Health, MEDLINE Plus Dec 2003.