New York, NY—December 17, 2003
A new clinical study, reported in the New England Journal of Medicine (December 18 issue), shows that atherosclerosis (build up of fatty deposits in arteries) occurs earlier in lupus patients and contrary to previous theories, it is independent of many risk factors normally associated with cardiovascular disease.
Physician-scientists Jane E. Salmon, MD, Director of the Mary Kirkland Center for Lupus Research at the Hospital for Special Surgery and Professor of Medicine at Weill Cornell Medical College and Mary J. Roman, MD, a cardiologist and Professor of Medicine at Weill Cornell Medical College and Attending Physician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center were the co-principal investigators of this first of its kind clinical study.
According to Dr. Salmon, "Over the past two decades, advances in treatment have dramatically increased the survival of lupus patients. Surprisingly some of the young women with lupus whom we care for at Hospital for Special Surgery were presenting with heart attacks. We hypothesized that this unexpected finding was due to chronic immune system activation leading to damage of coronary blood vessels."
The investigative group tested this possibility in a study that assessed the prevalence of atherosclerosis and cardiovascular disease risk factors in a population of lupus patients compared to that of matched health individuals. "While lupus is best known for leading to kidney, neurologic, skin and brain disease, we now know that lupus is also directly responsible for atherosclerotic plaque build-up that may result in heart attack, stroke, and other negative cardiovascular outcomes," says Dr. Roman.
"The current study’s results underscore the need for more focused and effective treatments that address more than just the disease’s symptoms," add Drs. Roman and Salmon. "Further clinical studies are needed to determine the best biomarker for the propensity to develop plaque, as well as the best treatment -- whether it is immunosuppressant drugs, statins, or other types of medications. However, the negative correlation between atherosclerosis and immunosuppressive treatments suggests that more vigorous therapy might decrease the likelihood and burden of atherosclerosis in lupus and, perhaps, in other chronic inflammatory diseases as well."
One hundred ninety seven people with lupus and the same number of matched controls were examined for this study. Of the enrolled patients with lupus, 37.1 percent (73 of 197) were found to have atherosclerosis, compared to 15.2 percent (30 of 197) of lupus-free patients with matched cardiovascular disease risk factors and demographic variables, indicating that lupus increased the likelihood of having atherosclerosis by 140 percent. The difference was even more pronounced in lupus patients 40 years and younger for whom the risk was increased by 480 percent. Not only is atherosclerosis more prevalent in patients with lupus, but the study also provides evidence that lupus disease-related factors cause atherosclerosis. This contradicts the prevailing hypothesis that atherosclerosis in lupus patients is attributable to an increased frequency of conventional risk factors such as hypertension, high cholesterol, smoking, and diabetes. As evidence, the authors note that while immunosuppressive (anti-inflammatory) drugs have the potential to exacerbate these risk factors, in fact, lupus patients who received the treatments showed a lower prevalence of atherosclerosis.
Lupus is a life-threatening illness, which attacks autoimmune systems. It is unrelated to AIDS or cancer, and it affects 1.4 million Americans. It can inflame joints and attack kidneys, hearts, lungs and livers, setting a patient''s body on a course of destroying its own healthy tissues. Nine of every ten patients are girls or women. Most of them are stricken during their childbearing years.
Atherosclerosis is the process in which deposits of fatty substances, cholesterol, cellular waste products, calcium, and other substances collect in the inner lining of an artery. This buildup is called plaque.
The study’s co-authors include Dr. Richard B. Devereux, Professor of Medicine at Weill Cornell Medical College and Attending Physician at NewYork-Presbyterian Hospital/Weill Cornell Medical Center; Dr. Ronit Simantov, formerly of NewYork-Presbyterian/Weill Cornell; Dr. Michael D. Lockshin, Dr. Lisa Sammaritano, Dr. Mary K. Crow, Dr. Stephen A. Paget, Beth-Ann Shanker, and Adrienne Davis of the Hospital for Special Surgery; and Dr. Joseph E. Schwartz of the State University of New York at Stony Brook.
The study is supported by grants from the National Institute of Arthritis, Musculoskeletal, and Skin Disease; the National Heart, Lung, and Blood Institute; and the Public Health Service.
About Hospital for Special Surgery
Hospital for Special Surgery (HSS) is the world’s largest academic medical center focused on musculoskeletal health. HSS is nationally ranked No. 1 in orthopedics and No. 2 in rheumatology by U.S. News & World Report (2016-2017), and is the first hospital in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center four consecutive times. HSS has one of the lowest infection rates in the country. HSS is an affiliate of Weill Cornell Medical College and as such all Hospital for Special Surgery medical staff are faculty of Weill Cornell. The hospital's research division is internationally recognized as a leader in the investigation of musculoskeletal and autoimmune diseases. Hospital for Special Surgery is located in New York City and online at www.hss.edu.