Endothelial Dysfunction, clinical corelation and atorvastatin therapy in patients with systemic lupus erythematosus

Abstract Background Systemic lupus erythematosus (SLE) patients have a significantly increased risk cardiovascular morbidity and mortality that are not fully explained by classic risk factors. Endothelial dysfunction is an early stage in the process of atherogenesis and the first step is decrease of endothelium dependent vasodilatation. Objectives The aim of the present study was to determine endothelial dysfunction in lupus patients, to compare to healthy volunteers and to correlate the results with the disease activity and laboratory markers and to evaluate atorvastatin efficacy in improving vasodilatation in SLE patients. Methods 20 SLE women and 20 healthy female subjects were assessed by non-invasive ultrasound on the brachial artery. Endothelium-dependent and independent function of the brachial artery was measured as flow-mediated dilatation (FMD) in response to reactive hyperemia (induced by 5 minutes compression) and nitroglycerin dilatation, respectively. A complete history, physical examination were performed and disease activity were assessed by the SLE Disease Activity Index (SLEDAI). Conventional risk factors for coronary heart disease, Raynaud's phenomenon, previous thrombosis, cardiovascular event, lipid profile, complement levels, antibodies to ds-DNA, anti-phospholipid antibodies were recorded. LES patients received atorvastain 80 mg/day during eight weeks and endothelium-dependent and independent function were evaluated at baseline and at the end of the study. Results Median age was 38 years; disease duration of SLE patients was 8 years (range 1 to 20 years). The patients show lupus activity ranging from 2 – 44 points in SLEDAI scale. The SLE patients had impaired flow-mediated dilation of the brachial artery compared with control subjects (9.6%; range 5.8% to 15.9% versus 26.5%; range 23.1% to 30.3% P Atorvastatin was associated with semnificativ increase in flow mediated dilatation in LES patient (4%, range 2,9-8,2 versus 7,3, range 4,3-10,2), p Conclusion Impaired endothelial function in SLE seems to be correlate with disease activity. Improving endothelial function may therefore have an impact on the risk of future cardiovascular disease and statins could be a good therapy.