Studies: Inflammation a Bad Actor for Heart

Find severe, early artery blockage in lupus patients

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HealthDay Reporter

WEDNESDAY, Dec. 17, 2003 (HealthDayNews) -- Two new studies showing accelerated accumulation of fatty deposits in the arteries of people with the autoimmune disease called systemic lupus erythematosus (SLE) support the growing belief that chronic inflammation plays a major role in cardiovascular disease, researchers say.

SLE is a condition in which the body's immune system mistakenly attacks its own tissue, causing inflammation of connective tissue such as tendon and cartilage. Patients have periodic bouts of symptoms including fever, fatigue and general malaise. It affects an estimated 1.5 million Americans, 90 percent of them women.

Doctors have long noted an excess incidence of cardiovascular disease in SLE patients. Now researchers at Vanderbilt University School of Medicine and Weill Medical College of Cornell University report in the Dec. 18 New England Journal of Medicine that their separate studies show atherosclerosis, the buildup of fatty deposits in the arteries, starts earlier and progresses faster in SLE patients.

"The clinical implications may be fairly profound," says Dr. Mary J. Roman, a professor of medicine and leader of the research group at Cornell. "Rather than just treating flare-ups, we need to effectively treat atherosclerosis in these patients."

The finding points directly to inflammation as a factor in atherosclerosis, Roman says: "We have to draw that conclusion on the basis of our data."

Dr. C. Michael Stein, an associate professor of medicine and leader of the Vanderbilt group, adds "that is why we started the study, based on the inflammatory hypothesis. We're not sure which aspect of inflammation is involved, but this kind of study may help us understand the relationship of atherosclerosis to inflammation in the general population."

The two groups used different techniques to obtain images of arteries in the SLE patients -- electron-beam computed tomography at Vanderbilt, ultrasonography and echocardiography at Cornell. Both got strikingly similar results.

Comparing 65 SLE patients with 69 people without the condition, the Vanderbilt group reports that in the SLE patients, "the prevalence of coronary-artery atherosclerosis is elevated and the age at onset is reduced."

After comparing 197 SLE patients with 197 people without the condition, the Cornell researchers report that "atherosclerosis occurs prematurely in patients with SLE and is independent of traditional risk factors."

"The next big step is to try to figure out what is the best way to retard progression of atherosclerosis," Roman says.

Her group is doing continuous study of the SLE patients. "We're hoping to be able to determine rates of progression that will allow us to design treatment trials," she says. "We are looking for some biomarker that correlates well with the progression of disease."

"We're doing the same sort of thing," says Stein. "The number of patients we have are relatively small at the moment, so we have to increase them. To better understand what is happening, we need a larger number of people, and we also need to know more about how atherosclerosis evolves over time."

More information

Get a primer on lupus from the National Institute of Arthritis and Muscular and Skin Diseases. To learn about inflammation's role in heart disease, turn to the American Heart Association.

SOURCES: Mary J. Roman, M.D., professor, medicine, Cornell University Weill Medical College, New York City; C. Michael Stein, M.D., associate professor, medicine, Vanderbilt University School of Medicine, Nashville, Tenn.; Dec. 18, 2003, New England Journal of Medicine

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