Implications of immunosuppressive agents in cardiovascular risks and carotid intima media thickness among lupus nephritis patients

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Introduction: Patients with systemic lupus erythematosus, particularly with lupus nephritis (LN), are at risk of premature cardiovascular (CV) disease.Objective: To determine the association between immunosuppressive medications, traditional CV risk factors and carotid intima media thickness (CIMT) among patients with LN.Methodology: This was a cross-sectional study in which consecutive LN patients attending the Nephrology/SLE Clinic were evaluated for traditional CV risk factors. Detailed information on their treatment was obtained from their medical records. CIMT, an excellent marker of subclinical atherosclerosis, was measured by B Mode carotid ultrasound.Results: A total of 82 patients with LN with a mean age of 33.9 ± 9.8 years were recruited. More than half had hypertension (n = 55, 67.1%) and dyslipidemia (n = 43, 52.4%) as traditional CV risks. Longer history and higher cumulative dose of corticosteroids were associated with hypertension, but use of intravenous methylprednisolone was associated with lower systolic and diastolic blood pressure and lower serum total cholesterol and triglyceride levels (p < 0.05 each). Hydroxychloroquine use was associated with lower total serum cholesterol and serum low-density lipoprotein levels (p < 0.05). Although the use of cyclosporine A (CyA) was associated with hypertension (p < 0.05), those who received a lower cumulative dose of CyA had thicker CIMT (rs = -0.33, p =0.01) and CyA use remained an independent predictor of CIMT during linear regression analysis. There were no associations between CIMT and cumulative dose and duration of steroids, hydroxychloroquine, azathioprine, mycophenolic acid and cyclophosphamide.Conclusion: Aggressive treatment of severe LN and the use of CyA as a steroid-sparing agent may have protective effects against premature atherosclerosis.

Original languageEnglish
Pages (from-to)1260-1266
Number of pages7
JournalLupus
Volume20
Issue number12
DOIs
Publication statusPublished - Oct 2011

Fingerprint

Carotid Intima-Media Thickness
Lupus Nephritis
Immunosuppressive Agents
Cyclosporine
Hydroxychloroquine
Hypertension
Atherosclerosis
Serum
Steroids
Mycophenolic Acid
Blood Pressure
Nephrology
Methylprednisolone
Azathioprine
Dyslipidemias
Systemic Lupus Erythematosus
LDL Cholesterol
Cyclophosphamide
Medical Records
Linear Models

Keywords

  • carotid media intimal thickness (CIMT)
  • cyclosporine A
  • lupus nephritis
  • traditional cardiovascular risk factors

ASJC Scopus subject areas

  • Rheumatology

Cite this

@article{b2516648c16d46ccae9cb8ba339e67cb,
title = "Implications of immunosuppressive agents in cardiovascular risks and carotid intima media thickness among lupus nephritis patients",
abstract = "Introduction: Patients with systemic lupus erythematosus, particularly with lupus nephritis (LN), are at risk of premature cardiovascular (CV) disease.Objective: To determine the association between immunosuppressive medications, traditional CV risk factors and carotid intima media thickness (CIMT) among patients with LN.Methodology: This was a cross-sectional study in which consecutive LN patients attending the Nephrology/SLE Clinic were evaluated for traditional CV risk factors. Detailed information on their treatment was obtained from their medical records. CIMT, an excellent marker of subclinical atherosclerosis, was measured by B Mode carotid ultrasound.Results: A total of 82 patients with LN with a mean age of 33.9 ± 9.8 years were recruited. More than half had hypertension (n = 55, 67.1{\%}) and dyslipidemia (n = 43, 52.4{\%}) as traditional CV risks. Longer history and higher cumulative dose of corticosteroids were associated with hypertension, but use of intravenous methylprednisolone was associated with lower systolic and diastolic blood pressure and lower serum total cholesterol and triglyceride levels (p < 0.05 each). Hydroxychloroquine use was associated with lower total serum cholesterol and serum low-density lipoprotein levels (p < 0.05). Although the use of cyclosporine A (CyA) was associated with hypertension (p < 0.05), those who received a lower cumulative dose of CyA had thicker CIMT (rs = -0.33, p =0.01) and CyA use remained an independent predictor of CIMT during linear regression analysis. There were no associations between CIMT and cumulative dose and duration of steroids, hydroxychloroquine, azathioprine, mycophenolic acid and cyclophosphamide.Conclusion: Aggressive treatment of severe LN and the use of CyA as a steroid-sparing agent may have protective effects against premature atherosclerosis.",
keywords = "carotid media intimal thickness (CIMT), cyclosporine A, lupus nephritis, traditional cardiovascular risk factors",
author = "Shaharir, {Syahrul Sazliyana} and {Mohamed Said}, {Mohd Shahrir} and Kong, {Ct Norella} and Tan, {Hui Jan} and Hamidon, {B. B.} and {Mohd. Tamil}, Azmi",
year = "2011",
month = "10",
doi = "10.1177/0961203311411347",
language = "English",
volume = "20",
pages = "1260--1266",
journal = "Lupus",
issn = "0961-2033",
publisher = "SAGE Publications Ltd",
number = "12",

}

TY - JOUR

T1 - Implications of immunosuppressive agents in cardiovascular risks and carotid intima media thickness among lupus nephritis patients

AU - Shaharir, Syahrul Sazliyana

AU - Mohamed Said, Mohd Shahrir

AU - Kong, Ct Norella

AU - Tan, Hui Jan

AU - Hamidon, B. B.

AU - Mohd. Tamil, Azmi

PY - 2011/10

Y1 - 2011/10

N2 - Introduction: Patients with systemic lupus erythematosus, particularly with lupus nephritis (LN), are at risk of premature cardiovascular (CV) disease.Objective: To determine the association between immunosuppressive medications, traditional CV risk factors and carotid intima media thickness (CIMT) among patients with LN.Methodology: This was a cross-sectional study in which consecutive LN patients attending the Nephrology/SLE Clinic were evaluated for traditional CV risk factors. Detailed information on their treatment was obtained from their medical records. CIMT, an excellent marker of subclinical atherosclerosis, was measured by B Mode carotid ultrasound.Results: A total of 82 patients with LN with a mean age of 33.9 ± 9.8 years were recruited. More than half had hypertension (n = 55, 67.1%) and dyslipidemia (n = 43, 52.4%) as traditional CV risks. Longer history and higher cumulative dose of corticosteroids were associated with hypertension, but use of intravenous methylprednisolone was associated with lower systolic and diastolic blood pressure and lower serum total cholesterol and triglyceride levels (p < 0.05 each). Hydroxychloroquine use was associated with lower total serum cholesterol and serum low-density lipoprotein levels (p < 0.05). Although the use of cyclosporine A (CyA) was associated with hypertension (p < 0.05), those who received a lower cumulative dose of CyA had thicker CIMT (rs = -0.33, p =0.01) and CyA use remained an independent predictor of CIMT during linear regression analysis. There were no associations between CIMT and cumulative dose and duration of steroids, hydroxychloroquine, azathioprine, mycophenolic acid and cyclophosphamide.Conclusion: Aggressive treatment of severe LN and the use of CyA as a steroid-sparing agent may have protective effects against premature atherosclerosis.

AB - Introduction: Patients with systemic lupus erythematosus, particularly with lupus nephritis (LN), are at risk of premature cardiovascular (CV) disease.Objective: To determine the association between immunosuppressive medications, traditional CV risk factors and carotid intima media thickness (CIMT) among patients with LN.Methodology: This was a cross-sectional study in which consecutive LN patients attending the Nephrology/SLE Clinic were evaluated for traditional CV risk factors. Detailed information on their treatment was obtained from their medical records. CIMT, an excellent marker of subclinical atherosclerosis, was measured by B Mode carotid ultrasound.Results: A total of 82 patients with LN with a mean age of 33.9 ± 9.8 years were recruited. More than half had hypertension (n = 55, 67.1%) and dyslipidemia (n = 43, 52.4%) as traditional CV risks. Longer history and higher cumulative dose of corticosteroids were associated with hypertension, but use of intravenous methylprednisolone was associated with lower systolic and diastolic blood pressure and lower serum total cholesterol and triglyceride levels (p < 0.05 each). Hydroxychloroquine use was associated with lower total serum cholesterol and serum low-density lipoprotein levels (p < 0.05). Although the use of cyclosporine A (CyA) was associated with hypertension (p < 0.05), those who received a lower cumulative dose of CyA had thicker CIMT (rs = -0.33, p =0.01) and CyA use remained an independent predictor of CIMT during linear regression analysis. There were no associations between CIMT and cumulative dose and duration of steroids, hydroxychloroquine, azathioprine, mycophenolic acid and cyclophosphamide.Conclusion: Aggressive treatment of severe LN and the use of CyA as a steroid-sparing agent may have protective effects against premature atherosclerosis.

KW - carotid media intimal thickness (CIMT)

KW - cyclosporine A

KW - lupus nephritis

KW - traditional cardiovascular risk factors

UR - http://www.scopus.com/inward/record.url?scp=80053631005&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=80053631005&partnerID=8YFLogxK

U2 - 10.1177/0961203311411347

DO - 10.1177/0961203311411347

M3 - Article

VL - 20

SP - 1260

EP - 1266

JO - Lupus

JF - Lupus

SN - 0961-2033

IS - 12

ER -