Says senior author and U-M rheumatologist Mariana Kaplan, M.D., "Even in the absence of other risk factors, these women have a tremendously high risk of dying young from cardiovascular events. Heart disease is the No. 3 cause of death among lupus patients, and we're only just beginning to understand why." She adds, "We need to characterize the mechanisms of endothelial cell damage, and understand its contribution to atherosclerosis and clot formation, to help patients and develop therapies for the future." Kaplan is an assistant professor of internal medicine at the U-M Medical School.
More than 1.4 million Americans, nearly all of them women in their 20s, 30s and 40s, have lupus. The disease causes the body's immune system to become hyperactive and form antibodies and immune complexes that attack normal tissues and organs. The disease can cause sporadic periods of fatigue, pain, organ damage and disability that persist for years. Many patients die prematurely of kidney failure, infection or cardiovascular diseases, such as heart attack or stroke.
Even at a young age, many people with lupus have narrowed or partially blocked coronary arteries, mainly caused by cholesterol deposits on the blood vessel walls (atherosclerosis). And in addition to damage done by the disease itself, they also face an increased risk of blood vessel blockage if they take corticosteroids like prednisone to reduce the severity of their autoimmune attacks.
The new study suggests that lupus patients' heightened heart risk may be due to the rapid death and much-too-slow replacement of endothelial cells, which normally keep plaques and clots from forming in blood vessels. Loss of these cells through accelerated apoptosis may affect vascular and heart health in many ways, says Rajagopalan, since endo
Contact: Kara Gavin
University of Michigan Health System