Cardiovascular risk factors and carotid atherosclerosis in patients with systemic lupus Erythematosus at the Kenyatta National Hospital

Abstract

Background: Cardiovascular disease is now acknowledged as a primary cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). The risk of developing coronary artery disease in these patients is four to eight times higher than that in the normal population. There has been paucity of data regarding cardiovascular risk in SLE patients in our setting. Objective: To determine the prevalence of selected cardiovascular risk factors and carotid atherosclerosis in patients with systemic lupus erythematosus. Methodology: This was a cross-sectional survey carried out in patients with SLE and age- and sex-matched controls at the Kenyatta National Hospital. The SLE patients underwent clinical assessment with measurement of their blood pressure, weight, height, waist and hip circumferences. They also underwent laboratory testing to determine their fasting blood sugar and fasting lipid profile. In addition, carotid Doppler ultrasonography was done for the lupus patients. The controls had similar clinical and laboratory assessment done as for controls. Carotid ultrasonography was however not done for controls. Results: Sixty six SLE patients and 66 healthy controls participated in this study. The mean age of the patients was 35.9 years, with a female to male ratio of 21:1 and a median duration of illness of two years. Hypertension prevalence was 42.4% in the patients and 24.2% in the controls (p=0.027), dyslipidemia occurred in 74.2% of the patients and 62.1% of the controls (p=0.135) while the prevalence of diabetes was 4.5% in patients and 1.5% in controls (p=0.619). Obesity by BMI assessment was found in 12.1% of patients and 21.2% of the controls (p=0.330) whereas abdominal obesity (by waist: hip ratio) occurred in 33.3% of patients and 24.2% of controls (p=0.249). Carotid atherosclerosis occurred in 19patients (28.8%) and was associated with longer duration of illness (p=0.040). Correlation between obesity (by BMI assessment) and longer disease duration was also found (p=0.021). 9 Conclusion: There was a high prevalence of atherosclerosis and selected cardiovascular risk factors in this population of SLE patients. Hypertension was significantly more common in the lupus patients than controls. Cardiovascular risk assessment and appropriate treatment of risk factors identified should be enhanced in patients with SLE.