Key result
Systemic lupus erythematosus was associated with significantly impaired endothelial function, evidenced by lower brachial artery flow-mediated dilation compared to healthy controls (SMD -1.077).
Why the study?
Does systemic lupus erythematosus impair brachial artery endothelium-dependent flow-mediated dilation compared to healthy controls?
Meta-Analysis (n=2,325)
Does systemic lupus erythematosus impair brachial artery endothelium-dependent flow-mediated dilation compared to healthy controls?
Standardized Mean Difference: -1.077 (95% CI -1.497–-0.657)
p-value: p=<0.001
SLE patients without cardiovascular disease have significantly impaired endothelial function, which is further exacerbated by diabetes, renal disease, and diastolic hypertension.
Impaired endothelial function in SLE without CVD may flag higher CV risk; this Level 4 evidence leaves open whether targeting contributors improves outcomes.
Endothelium-dependent flow-mediated dilation (ED-FMD), a biophysical marker of endothelial dysfunction, is apparently impaired in patients with systemic lupus erythematosus (SLE) but such observation is inconsistent. Here, we assessed and compared the brachial artery ED-FMD (baED-FMD) using ultrasonography between SLE patients without cardiovascular disease and healthy controls (HC) matched for age, gender and body mass index. We then performed a comprehensive meta-analysis of case-control studies which compared baED-FMD between SLE patients and HC by determining the effect size of baED-FMD as standardized mean difference (SMD). Factors associated with the effect size were explored by mixed-model meta-regression. Seventy one SLE patients and 71 HC were studied. SLE patients had lower baED-FMD than HC (3.72 ± 2.8% vs 4.63 ± 3.1%, p = 0.032). Meta-analysis of 25 case-control studies involving 1,313 SLE patients and 1,012 HC with the random effects model revealed lower baED-FMD in SLE patients compared to HC (SMD -1.077, p < 0.001). The presence of diabetes mellitus (p = 0.04747), higher diastolic blood pressure (p = 0.044), renal involvement (p = 0.027) and aspirin use (p = 0.001) were associated with more discrepant baED-FMD between both groups. In conclusion, SLE patients naïve of cardiovascular disease have impaired endothelial function. Diabetes mellitus, renal disease and diastolic hypertension are major contributors of endothelial dysfunction in SLE patients.
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Mak et al. (2017) conducted a meta-analysis in Systemic lupus erythematosus (n=2,325). Systemic lupus erythematosus vs. Healthy controls was evaluated on Brachial artery endothelium-dependent flow-mediated dilation (baED-FMD) (SMD -1.077, 95% CI -1.497 to -0.657, p=<0.001). Systemic lupus erythematosus was associated with significantly impaired endothelial function, evidenced by lower brachial artery flow-mediated dilation compared to healthy controls (SMD -1.077).
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