New Risk Factor Found for Future Cardiovascular Disease in Patients With Systemic Lupus Erythematosus

Investigators have found a link between positive antiphospholipid antibodies (aPL) and an increase in the risk of future cardiovascular disease (CVC) in individuals with systemic lupus erythematosus (SLE), according to results of a study presented at the American College of Rheumatology Convergence 2023.

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aPLs are directed against phospholipid-binding proteins, and antiphospholipid syndrome has been associated with heart attack, stroke, pulmonary embolism, miscarriage, and stillbirth, according to a press release.

“Few studies have demonstrated the role of different aPL isotopes in [atherosclerotic CVD (ASCVD)] development. In our study, we identified that [anticardiolipin antibodies (aCL)] IgG, aCL IgM and lupus anticoagulant positivity are independently associated with ASCVD after adjusting for traditional [CVD] risk factors,” Yufang Ding, a medical student at Peking Union Medical College Hospital, Beijing, China, said in the press release.

For patients with SLE, there is an increased risk of CVD, which is a major cause of morbidity and mortality, and approximately 30% to 40% have aPLs, according to the press release. Ding and colleagues investigated the association between aPLs and the future of atherosclerotic CVD because there has been little understanding about how the antibodies affect CVD risk. There were more than 1500 individuals with lupus included in the study. Data were included from the Chinese SLE Treatment and Research Group from 2006 and 2021, with 90% women and 100% East Asian, according to the press release.

There were 7 different aPL isotopes measured at diagnosis and during the follow-up, including aCL antibodies such as IgG, IgM, IgA; anti-beta-2-glycoprotein I (aβ2GPI) antibodies such as IgG, IgM, and IgA; and lupus anticoagulant. Of the individuals included, 33.4% had positive aPLs, with lupus anticoagulant being the most prevalent at 20.6%, followed by aCL IgG at 15.8%, according to the press release. Investigators also reported that 116 individuals—92 of whom were aPL positive—developed ASCVD during the 4.5-year follow up. Investigators defined ASCVD as a new nonfatal heart attack, nonfatal stroke, coronary or peripheral artery revascularization, or CVD-related death, according to the press release. There were 3 analyses conducted.

Investigators found that aPL positivity and traditional risk factors were associated with ASCVD, and aCL IgG, aCL IgM, and lupus anticoagulant were independently associated with ASCVD, according to the press release. Furthermore, the traditional risk factors of smoking, hypertension, gender, and age were independently associated with ASCVD. Furthermore, anticoagulant and antiplatelet therapies can reduce ASCVD risk in patients with SLE, according to the investigators of the study.

According to Ding, the results suggested that patients with lupus should be tested for aPL, and those with aPL should undergo careful surveillance for future heart disease.

“The use of low-dose aspirin for primary thrombosis prevention should be carefully considered in patients [with SLE] with positive anticardiolipin antibodies or lupus anticoagulant. We are also looking forward to discussing the prevention role of the Mediterranean diet and exercise through an intervention study in the future,” Ding said in the press release.

The study had some limitations, including the dynamic and timing-varying interplay of aPL positivity, which Ding said could make the statistical analysis challenging. Further, the study was observational, which made accounting for confounding factors, including treatment choices and outcomes, difficult, according to the press release.

Reference

Study finds positive antiphospholipid antibodies raises cardiovascular disease risk in patients with systemic lupus erythematosus. New release. EurekAlert. November 7, 2023. Accessed December 1, 2023. https://www.eurekalert.org/news-releases/1007316