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Dysfunctional proinflammatory high-density lipoproteins confer increased risk of atherosclerosis in women with systemic lupus erythematosus.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	McMahon, Maureen Grossman, Jennifer Skaggs, Brian Fitzgerald, John Sahakian, Lori Ragavendra, Nagesh Charles-Schoeman, Christina Watson, Karol Wong, Weng Kee Volkmann, Elizabeth Chen, Weiling Gorn, Alan Karpouzas, George Weisman, Michael Wallace, Daniel J. Hahn, Bevra H.
Spatial Coverage	California
Description	Country affiliation: United States Author Affiliation: McMahon M ( David Geffen School of Medicine, UCLA Medical Center, University of California, Los Angeles, CA 90095, USA. mmcmahon@mednet.ucla.edu)
Abstract	OBJECTIVE: Women with systemic lupus erythematosus (SLE) have an increased risk of atherosclerosis. Identification of at-risk patients and the etiology underlying atherosclerosis in SLE remain elusive. The antioxidant capacity of normal high-density lipoproteins (HDLs) is lost during inflammation, and these dysfunctional HDLs might predispose individuals to atherosclerosis. The aim of this study was to determine whether dysfunctional proinflammatory HDL (piHDL) is associated with subclinical atherosclerosis in SLE. METHODS: Carotid artery ultrasound was performed in 276 women with SLE to identify carotid plaques and measure intima-media thickness (IMT). The antioxidant function of HDL was measured as the change in oxidation of low-density lipoprotein after the addition of HDL cholesterol. Two antiinflammatory HDL components, paraoxonase 1 and apolipoprotein A-I, were also measured. RESULTS: Among the SLE patients, 48.2% were determined to have piHDL on carotid ultrasound, while 86.7% of patients with plaque had piHDL compared with 40.7% of those without plaque (P<0.001). Patients with piHDL also had a higher IMT (P<0.001). After multivariate analysis, the only factors found to be significantly associated with plaque were the presence of piHDL (odds ratio [OR] 16.1, P<0.001), older age (OR 1.2, P<0.001), hypertension (OR 3.0, P=0.04), dyslipidemia (OR 3.4, P=0.04), and mixed racial background (OR 8.3, P=0.04). Factors associated with IMT measurements in the highest quartile were the presence of piHDL (OR 2.5, P=0.02), older age (OR 1.1, P<0.001), a higher body mass index (OR 1.07, P=0.04), a cumulative lifetime prednisone dose>or=20 gm (OR 2.9, P=0.04), and African American race (OR 8.3, P=0.001). CONCLUSION: Dysfunctional piHDL greatly increases the risk of developing subclinical atherosclerosis in SLE. The presence of piHDL was associated with an increased prevalence of carotid plaque and with a higher IMT. Therefore, determination of piHDL may help identify patients at risk for atherosclerosis.
File Format	HTM / HTML
ISSN	00043591
e-ISSN	15290131
DOI	10.1002/art.24677
Journal	Arthritis & Rheumatism
Issue Number	8
Volume Number	60
Language	English
Publisher	Wiley-Blackwell
Publisher Date	2009-08-01
Publisher Place	United States
Access Restriction	Open
Subject Keyword	Research Support, N.i.h., Extramural Research Support, Non-u.s. Gov't Comorbidity Risk Factors Epidemiology Blood Pathology Lupus Erythematosus, Systemic Atherosclerosis Carotid Stenosis Diagnosis Discipline Rheumatic Diseases Lipoproteins, Ldl
Content Type	Text
Resource Type	Article
Subject	Immunology and Allergy Immunology Pharmacology (medical) Rheumatology

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