Impaired brachial artery endothelium dependent flow mediated dilation in systemic lupus erythematosus: preliminary observations

Abstract

Our objective was to compare brachial artery endothelium dependent and independent vasodilation in lupus patients and healthy females, by means of high-resolution noninvasive brachial artery ultrasound. Endothelially mediated vasodilation was estimated noninvasively by examination of brachial artery responses to postischemic reactive hyperemia and endothelial independent vasodilation from response to sublingual glycerlynitrate (GTN) using high-resolution external vascular ultrasound. Five patients with known coronary artery disease (CAD), five with subclinical CAD, five with no CAD and five control subjects were assessed. Endothelium dependent vasodilation was significantly blunted in lupus patients with CAD as compared with healthy female controls (0.11 versus 11.1%, P ¹/4 0.018). Corresponding values for lupus patients with subclinical CAD and no CAD were 11 and 9.6%, respectively. For each subject, endothelium dependent vasodilation (EDV) was related to endothelium independent vasodilation (EIV) to adjust for varying vascular smooth muscle responses to GTN in individual subjects. This ratio was markedly depressed in lupus patients with CAD as compared with control subjects (0.12 versus 1.15). The corresponding EDV/EIV ratios for patients with subclinical CAD and no CAD were similar at 0.69 and 0.65, respectively. The conclusion was that flow mediated vasodilation in lupus patients with coronary artery disease is markedly depressed as compared to healthy subjects.

Keywords

atherosclerosis coronary artery disease endothelial function systemic lupus erythematosus

Get full access to this article

View all access options for this article.

References

Urowitz MB , Bookman AA , Koehler BE , Gordon DA , Smythe HA , Ogryzlo MA. The bimodal mortality pattern of systemic lupus erythematosus . Am J Med 1976; 60: 221-225 .

Rubin LA , Urowitz MB , Gladman DD. Mortality in systemic lupus erythematosus: the bimodal pattern revisited . Q J Med 1985; 55: 87-98 .

Bruce IN , Gladman DD , Urowitz MB. Premature atherosclerosis in systemic lupus erythematosus . Rheum Dis Clin North Am 2000; 26: 257-278 .

Manzi S , Meilahn EN , Rairie JE et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study . Am J Epidemiol 1997; 145: 408-415 .

Hosenpud JD , Montanaro A , Hart MV et al. Myocardial perfusion abnormalities in asymptomatic patients with systemic lupus erythematosus . Am J Med 1984; 77: 286-292 .

Selzer F , Sutton-Tyrrell K , Fitzgerald S , Tracy R , Kuller L , Manzi S. Vascular stiffness in women with systemic lupus erythematosus . Hypertension 2001; 37: 1075-1082 .

Manzi S , Selzer F , Sutton-Tyrrell K et al. Prevalence and risk factors of carotid plaque in women with systemic lupus erythematosus . Arthritis Rheum 1999; 42: 51-60 .

Bruce IN , Burns RJ , Gladman DD , Urowitz MB. Single photon emission computed tomography dual isotope myocardial perfusion imaging in women with systemic lupus erythematosus. I. Prevalence and distribution of abnormalities . J Rheumatol 2000; 27: 2372-2377 .

Mombouli JV , Vanhoutte PM. Endothelial dysfunction: from physiology to therapy . J Mol Cell Cardiol 1999; 31: 61-74 .

10.

Ganz P , Vita JA. Testing endothelial vasomotor function: nitric oxide, a multipotent molecule . Circulation 2003; 108: 2049-2053 .

11.

Corretti MC , Anderson TJ , Benjamin EJ et al. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force . J Am Coll Cardiol 2002; 39: 257-265 .

12.

Chan CT , Harvey PJ , Picton P , Pierratos A , Miller JA , Floras JS. Short-term blood pressure, noradrenergic, and vascular effects of nocturnal home hemodialysis . Hypertension 2003; 42: 925-931 .

13.

Leeson P , Thorne S , Donald A , Mullen M , Clarkson P , Deanfield J. Noninvasive measurement of endothelial function: effect on brachial artery dilatation of graded endothelial dependent and independent stimuli . Heart 1997; 78: 22-27 .

14.

Anderson TJ , Uehata A , Gerhard MD et al. Close relation of endothelial function in the human coronary and peripheral circulations . J Am Coll Cardiol 1995; 26: 1235-1241 .

15.

Perticone F , Ceravolo R , Pujia A et al. Prognostic significance of endothelial dysfunction in hypertensive patients . Circulation 2001; 104: 191-196 .

16.

Tan EM , Cohen AS , Fries JF et al. The 1982 revised criteria for the classification of systemic lupus erythematosus . Arthritis Rheum 1982; 25: 1271-1277 .

17.

Gladman DD , Ibanez D , Urowitz MB. Systemic lupus erythematosus disease activity index 2000 . J Rheumatol 2002; 29: 288-291 .

18.

Ibanez D , Urowitz MB , Gladman DD. Summarizing disease features over time: I. Adjusted mean SLEDAI derivation and application to an index of disease activity in lupus . J Rheumatol 2003; 30: 1977-1982 .

19.

Lima DS , Sato EI , Lima VC , Miranda F , Hatta FH. Brachial endothelial function is impaired in patients with systemic lupus erythematosus . J Rheumatol 2002; 29: 292-297 .

20.

Munzel T , Feil R , Mulsch A , Lohmann SM , Hofmann F , Walter U. Physiology and pathophysiology of vascular signaling controlled by cyclic guanosine 30,50-cyclic monophosphate-dependent protein kinase . Circulation 2003; 108: 2172-2183 .

21.

Verma S , Anderson TJ. Fundamentals of endothelial function for the clinical cardiologist . Circulation 2002; 105: 546-549 .

22.

Sondergaard E , Moller JE , Egstrup K. Effect of dietary intervention and lipid-lowering treatment on brachial vasoreactivity in patients with ischemic heart disease and hypercholesterolemia . Am Heart J 2003; 145: E19-E19 .

23.

Chenevard R , Hurlimann D , Bechir M et al. Selective COX-2 inhibition improves endothelial function in coronary artery disease . Circulation 2003; 107: 405-409 .

24.

Mancini GB , Henry GC , Macaya C et al. Angiotensin-converting enzyme inhibition with quinapril improves endothelial vasomotor dysfunction in patients with coronary artery disease. The TREND (Trial on Reversing ENdothelial Dysfunction) Study . Circulation 1996; 94: 258-265 .

25.

Mercuro G , Zoncu S , Saiu F , Sarais C , Rosano GM. Effect of atorvastatin on endothelium-dependent vasodilation in postmenopausal women with average serum cholesterol levels . Am J Cardiol 2002; 90: 747-750 .

26.

Poldermans D , Bax JJ , Kertai MD et al. Statins are associated with a reduced incidence of perioperative mortality in patients undergoing major noncardiac vascular surgery . Circulation 2003; 107: 1848-1851 .