Hyperhomocysteinemia and metabolic syndrome are risk factors for sub-clinical atherosclerosis in women with systemic lupus erythematosus

Aim of the workThis study aimed to measure serum levels of homocysteine (sHcy) and to study the presence of the metabolic syndrome (MetS) in women with systemic lupus erythematosus (SLE) and to correlate them with disease activity, clinical status and sub-clinical atherosclerosis.Patients and methodsThis study included 30 adult SLE female patients and 20 age and sex matched apparently healthy volunteers as the control group. Disease activity and damage were assessed using the SLE disease activity index (SLEDAI) score and Systemic Lupus International Collaborative Clinics (SLICC) damage index, respectively. The MetS was diagnosed according to the National Cholesterol Education Program’s Adult Treatment Panel III (NCEP-ATPIII). Total sHcy was measured by enzyme immunoassay. B mode ultrasound was done to measure the carotid intima-media thickness (CIMT).ResultsThe mean CIMT (0.97 ± 0.26 mm) and sHcy (46.96 ± 22.07 μmol/L) were significantly higher in patients compared to the controls (0.43 ± 0.22 mm and 4.19 ± 1.49 μmol/L, respectively) (p < 0.001). The mean CIMT significantly correlated (p < 0.001) with patient age (r = 0.52), disease duration (r = 0.69), SLEDAI (r = 0.66), SLICC (r = 0.82), sHcy (r = 0.53), total cholesterol (r = 0.51), triglycerides (r = 0.77), low density lipoprotein (r = 0.53), fasting blood sugar (r = 0.75), systolic (r = 0.68) and diastolic (r = 0.64) blood pressure and negatively with C3 (r = −0.54), high density lipoprotein (HDL) (r = −0.56), platelets (r = −0.55) and white blood cell counts (r = −0.51). Patients with MetS had statistically significantly higher CIMT (1.25 ± 0.09 mm) and sHcy (56 ± 19.31 μmol/L) versus those without (0.79 ± 0.16 mm and 40.5 ± 21.9 μmol/L, p < 0.001 and p = 0.048, respectively).ConclusionWe can conclude that SLE itself is considered a risk factor for accelerated atherosclerosis and this is amplified by multiple factors.