Presence of endothelial dysfunction expressed by flow-mediated brachial artery dilation values in patients with primary antiphospholipid syndrome

Introduction: Primary antiphospholipid syndrome (PAPS) is a rare autoimmune disease characterized by arterial/venous thrombosis and/or obstetric pathology in the presence of antiphospholipid antibodies (aPL). Evidence suggests that aPL directly interact with membrane phospholipids of endothelial cells, leading to endothelial dysfunction (ED) and accelerating atherosclerosis. Methods: This study aimed to establish the presence of ED, expressed by a decrease in the percentage of flow-mediated brachial artery dilation (FMD), in a cohort of 100 Serbian PAPS patients without previously diagnosed cardiovascular disease. All participants underwent clinical evaluation to identify standard atherosclerotic risk factors. Tested aPL included: lupus anticoagulant (LA), anticardiolipin antibodies (aCL IgG/IgM), and anti-β2-glycoprotein I antibodies (a-β2GPI IgG/IgM). FMD was measured following standardized patient preparation and compared to results from 80 healthy controls. Results: The study cohort consisted predominantly of females age 47.7 ± 8.5 years with a low prevalence of conventional risk factors. ED, reflected by reduced FMD values, was present in 37.6% of PAPS patients, significantly more than in the control group (p = 0.0001). Age (p = 0.041) and glycemia value (p = 0.045) were significantly associated with ED. However, aPL type and clinical manifestations were not. Multivariate regression including age, glycemia value and thrombosis history showed no independent predictors of ED. Conclusion: ED is significantly more prevalent in PAPS patients than in healthy individuals, and represents a direct consequence of the autoimmune process. Earlier involvement of a cardiologist and appropriate management may reduce the risk of future cardiovascular complications.