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Dyslipidemia in systemic lupus erythematosus

  • Novel Aspects in Lupus, 2017
  • Published:
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Abstract

Cardiovascular disease is one of the major causes of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Accelerated atherosclerosis is related to traditional (age, hypertension, diabetes mellitus, dyslipidemia, obesity, smoking, and positive family history) and non-traditional, disease-related factors. Traditional risk factors are still more prominent in patients with lupus, as both hypertension and hypercholesterinemia were independently associated with premature atherosclerosis in several SLE cohorts. In this work, the authors summarize the epidemiology of dyslipidemia in lupus patients and review the latest results in the pathogenesis of lipid abnormalities. The prevalence of dyslipidemia, with elevations in total cholesterol (TC), low-density lipoprotein (LDL), triglyceride (TG), and apolipoprotein B (ApoB), and a reduction in low-density lipoprotein (LDL) levels are about 30% at the diagnosis of SLE rising to 60% after 3 years. Multiple pathogenetic mechanism is included, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) can suppress HDL and increase TG, auto-antibodies can cause the injury of the endothelium, lipoprotein lipase (LPL) activity can be reduced by circulating inflammatory mediators and antibodies, and increased oxidative stress may trigger a wide range of pro-atherogenic lipid modifications. As a major risk factor, dyslipidemia should be treated aggressively to minimize the risk of atherosclerosis and cardiovascular events. Randomized controlled trials with statins are controversial in the detention of atherosclerosis progression, but can be favorable by inhibiting immune activation that is the arterial wall and by decreasing lupus activity.

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Abbreviations

anti-oxLDL:

Anti oxidized low-density lipoprotein

Apo:

Apolipoprotein

β2GPI β2 :

glikoproteini

CEC:

Cholesterol efflux capacity

cIMT:

Carotid intima-media thickness

CRP:

C-reactive protein

CV:

Cardiovascular

CVD:

Cardiovascular disease

DNA:

Deoxyribonucleic acid

ED:

Endothel dysfunction

ESR:

Erythrocyte sedimentation rate

HCQ:

Hydroxychloroquine

HDL:

High-density lipoprotein

IDL:

Intermediate-density lipoprotein

IFN-γ:

Interferon γ

ICAM:

Intracellular cell adhesion molecule

Ig:

Immunoglobulin

IL:

Interleukin

LDL:

Low-density lipoprotein

LPL:

Lipoprotein lipase

LN:

Lupus nephritis

MCP-1:

Monocyte chemoattractant protein-1

MPO:

Myeloperoxidase

NET:

Neutrophil extracellular trap

NOS:

Nitric oxide synthetase

NOX:

NADPH oxidase

oxLDL:

Oxidized low-density lipoprotein

PAF-AH:

Platelet activating factor acetylhydrolase

PON:

Paraoxonase

SSA:

Serum amyloid A

SLAM-R:

Systemic lupus activity measure-revised

SLE:

Systemic lupus erythematosus

SLEDAI:

Systemic lupus erythematosus disease activity

TC:

Total cholesterol

TG:

Triglyceride

TNF-α:

Tumor necrosis factor α

VCAM:

Vascular cell adhesion molecule

VEGF:

Vascular endothelial growth factor

VLDL:

Very low-density lipoprotein

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Authors and Affiliations

  1. Department of Clinical Immunology, Adult and Pediatric Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary

    Melinda Zsuzsanna Szabó & Emese Kiss

  2. Institute of Immunology, Rikshospitalet, Oslo University, Oslo, Norway

    Peter Szodoray

  3. IIIrd Department of Internal Medicine, Semmelweis University, Budapest, Hungary

    Emese Kiss

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  1. Melinda Zsuzsanna Szabó
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Correspondence to Melinda Zsuzsanna Szabó.

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Szabó, M.Z., Szodoray, P. & Kiss, E. Dyslipidemia in systemic lupus erythematosus. Immunol Res 65, 543–550 (2017). https://doi.org/10.1007/s12026-016-8892-9

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