Review Reduced flow-mediated vasodilation as a marker for cardiovascular complications in lupus patients Emese Kiss a , Pal Soltesz a , Henrietta Der a , Zsolt Kocsis a , Tunde Tarr a , Harjit Bhattoa b , Yehuda Shoenfeld c, * , Gyula Szegedi a,d a Third Department of Internal Medicine, Medical and Health Science Centre, University of Debrecen, Debrecen, Hungary b Department of Clinical Biochemistry and Molecular Pathology, Medical and Health Science Centre, University of Debrecen, Debrecen, Hungary c Department of Medicine B and Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Incumbent of the Laura Schwarz-Kipp Chair for Research of Autoimmune Diseases, Sackler Faculty of Medicine, Tel-Aviv University, 52621 Tel-Hashomer, Israel d Autoimmune Research Group of the Hungarian Academy of Sciences and University of Debrecen, Debrecen, Hungary Received 3 August 2006; revised 20 September 2006; accepted 28 September 2006 Abstract Systemic lupus erythematosus is associated with accelerated atherosclerosis and increased cardiovascular morbidity and mortality. Objectives were to determine endothelial dysfunction with a non-invasive method in lupus patients and to analyse correlation with risk factors and atherosclerotic complications. Sixty-one SLE patients and 26 healthy age- and sex-matched control subjects were entered into the study. The diameters of brachial artery at rest, during reactive hyperaemia, and after glyceril trinitrate administration, as well as the intima-media thickness of the common carotid artery were measured using high-resolution B-mode ultrasonography. Demographic characteristics, lipid profile, paraoxonase activity, concentration of anti-phospholipid antibodies and anti-oxLDL were assessed together with atherosclerotic complications. The endothelium dependent vasodilation (FMD) was significantly impaired in SLE patients as compared to controls. The absolute difference of vessel diameter (Dd) was 0.25  0.15 mm vs. 0.38  0.16 mm ( p ¼ 0.001), and Dd as in percent of the rest diameter was 7.31  5.2% vs. 9.86  3.87% ( p ¼ 0.013) in lupus patients and controls, respectively. Nitrate mediated dilation (NMD) did not differ. FMD negatively corre- lated with age, systolic and diastolic blood pressure in SLE, but did not show significant correlation with the other examined parameters. How- ever, FMD significantly differed between SLE patients with (5.54  4.36%) and without (8.81  5.28%) cardiovascular complications ( p ¼ 0.01). The determination of flow-mediated vasodilation is a useful method to detect endothelial dysfunction in lupus patients, as reduced capacity of brachial artery may distinguish between SLE patients and healthy subjects, as well as lupus patients with and without atherosclerotic vascular complications. Ó 2006 Elsevier Ltd. All rights reserved. Keywords: SLE; FMD; Atherosclerosis; Endothelial dysfunction 1. Introduction Systemic lupus erythematosus (SLE) is a chronic inflamma- tory, autoimmune disorder. Life expectancy of lupus patients has increased in the past ten years, as such, accelerated atherosclerosis with consequent cardio- and cerebrovascular events have become the major causes of morbidity and mortal- ity in lupus patients [1e4]. In one such study SLE women aged 44e50 had 7.5-fold increased risk to develop coronary heart disease compared with controls, even after adjusting for classi- cal risk factors [5]. Since SLE-related cardiovascular diseases could give insights into the nature of autoimmunity in athero- sclerosis in general there is increased focus on autoimmune * Corresponding author. Tel.: þ972 03 530 2652; fax: þ972 03 535 2855. E-mail address: shoenfel@post.tau.ac.il (Y. Shoenfeld). 0896-8411/$ - see front matter Ó 2006 Elsevier Ltd. All rights reserved. doi:10.1016/j.jaut.2006.09.008 Journal of Autoimmunity 27 (2006) 211e217 www.elsevier.com/locate/issn/08968411