Cardiometabolic and immune factors associated with increased common carotid artery intima-media thickness and cardiovascular disease in patients with systemic lupus erythematosus

E. Ammirati, E. P. Bozzolo, R. Contri, A. Baragetti, A. G. Palini, D. Cianflone, M. Banfi, P. Uboldi, G. Bottoni, I. Scotti, A. Pirillo, L. Grigore, K. Garlaschelli, C. Monaco, A. L. Catapano, M. G. Sabbadini, A. A. Manfredi, G. D. Norata

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Background and aim: Patients with systemic lupus erythematosus (SLE) have a higher prevalence of subclinical atherosclerosis and higher risk of cardiovascular (CV) events compared to the general population. The relative contribution of CV-, immune- and disease-related risk factors to accelerated atherogenesis in SLE is unclear. Methods and results: Fifty SLE patients with long-lasting disease (mean age 44±10 years, 86% female) and 50 sex- and age-matched control subjects were studied. Common carotid artery intima-media thickness (CCA-IMT) was used as a surrogate marker of atherosclerosis. We evaluated traditional and immune- and disease-related factors, assessed multiple T-cell subsets by 10-parameter-eight-colour polychromatic flow cytometry and addressed the effect of pharmacological therapies on CCA-IMT. In SLE patients, among several cardiometabolic risk factors, only high-density lipoprotein levels (HDL) and their adenosine triphosphate-binding cassette transporter 1 (ABCA-1)-dependent cholesterol efflux capacity were markedly reduced (p+HLA-DR+ and CCR5+ T-cell subsets were expanded in SLE patients. Patients under hydroxychloroquine (HCQ) therapy showed lower CCA-IMT (0.62±0.08 vs. 0.68±0.10mm; p=0.03) and better risk-factor profile and presented reduced circulating pro-atherogenic effector memory T-cell subsets and a parallel increased percentage of naïve T-cell subsets. Conclusion: HDL represents the main metabolic parameter altered in SLE patients. The increased CCA-IMT in SLE patients may represent the net result of a process in which 'classic' CV risk factors give a continuous contribution, together with immunological factors (CD4+HLA-DR+ T cells) which, on the contrary, could contribute through flares of activity of various degrees over time. Patients under HCQ therapy present a modified metabolic profile, a reduced T-cell activation associated with decreased subclinical atherosclerosis.

Original languageEnglish
Pages (from-to)751-759
Number of pages9
JournalNutrition, Metabolism and Cardiovascular Diseases
Issue number7
Publication statusPublished - 2014


  • Atherosclerosis
  • Cardiovascular risk factors
  • Carotid intima-media thickness
  • CCR5
  • HLA-DR
  • Hydroxychloroquine
  • Memory effector T cells
  • Systemic lupus erythematosus

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics
  • Endocrinology, Diabetes and Metabolism
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)


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