Endothelial dysfunction in Iranian lupus patients

Atherosclerosis has a high prevalence in systemic lupus erythematosus (SLE) patients and vascular endothelial dysfunction is the earliest stage of atherosclerosis. The aim of this study was to evaluate the prevalence of vascular endothelial dysfunction and its risk factors in SLE patients and to identify its correlation with disease activity, duration and concomitant conditions in these patients. A total of 84 female SLE patients and 18 healthy young women were included. The vascular endothelial function was evaluated via ultrasonographic assessment of the brachial artery diameter to determine flow-mediated dilation (FMD) and post-TNG dilation–FMD gap (PFG) indexes. FMD indexes of one standard deviation lower than mean FMD of the control group were considered as impaired, and PFG indexes of one standard deviation more than mean PFG of the control group were defined as impaired. SLE patients had a higher prevalence of impaired FMD than healthy subjects (48.8 vs. 5.5%). The prevalence of impaired PFG in SLE cases and healthy subjects was 25 and 5.5%, respectively. FMD and PFG impairment did not have any significant correlation with disease activity, duration, presence of anti-dsDNA, anticardiolipin antibodies, antiphospholipid syndrome and history of receiving cyclophosphamide pulses. Vascular endothelial dysfunction is very common in SLE patients and no single specific factor can explain this finding. We recommend the application of brachial artery Doppler ultrasound as a screening test for detection of early stages of atherosclerosis in SLE patients.