Serum biomarker may predict atherosclerosis in patients with systemic lupus erythematosus

Liz Meszaros, MDLinx | July 06, 2017

In patients with systemic lupus erythematosus (SLE), the presence of a specific biomarker—high sensitivity cardiac troponin T (HS-cTnT)—may be associated with the presence of atherosclerosis, despite the absence of any symptoms of cardiovascular disease (CVD), according to study results presented at the Annual European Congress of Rheumatology (EULAR 2017).

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Simple test for serum biomarker

Patients in whom the presence of high sensitivity cardiac troponin T (HS-cTnT) was discovered have an 8-fold increase in their risk for carotid plaques.

“The results of our study raise the possibility that this easily measured biomarker could be introduced into clinical practice as a more reliable way of evaluating CVD risk in lupus patients,” said lead author Dr. Karim Sacré, MD, Bichat Hospital, Paris, France. “This in turn will enable more effective primary prevention measures such as treating abnormally raised blood lipids to be implemented,” he added.

In lupus patients, CVD has become a major cause of illness and death, and studies have shown that the assessment of traditional CVD risk factors, such as the Framingham score, may underestimate the risk of CVD in these patients.

Dr. Sacré and colleagues prospectively assessed the presence of carotid plaques via ultrasound in 63 SLE subjects who were asymptomatic for CVD and 18 controls. They measured serum HS-cTnT concentrations with electrochemiluminescence.

In both SLE patients and controls, Framingham scores were low (2.1±3.8% and 2.1±2.9%, respectively). Yet carotid plaques were found in 36.5% of SLE patients, and only 11.1% of controls (P=0.039). Upon multivariate analysis, researchers found that only age (P=0.006) and SLE status (P=0.017) were independently associated with carotid plaques.

Serum HS-cTnT concentrations were detectable (over 3 ng/L) in 58.7% of SLE patients compared with 33.3% of controls (P=0.057).

A full 87% of SLE patients with carotid plaques had detectable HS-cTnT, compared with only 42.5% of SLE patients without plaques (P < 0.001). Conversely, 54.5% of SLE patients with detectable HS-cTnT had a carotid plaque, while only 11.5% with an undetectable HS-cTnT did (P < 0.001). Upon multivariate analysis, researchers found that only body mass index (P=0.006) and HScTnT (P=0.033) were statistically associated with the presence of carotid plaques in SLE patients.

Overall, the risk of having a carotid plaque was increased by 8 (OR: 8.03, 95% CI: 1.41–74.73) in SLE patients in whom HS-cTnT was detectable in serum.

These results suggest that this easily obtained serum biomarker may help clinicians engage in better risk stratification and prevention of CVD in patients with SLE. But, cautioned Dr. Sacré, more research is needed.

“Before introducing this new biomarker into clinical practice, we are conducting further research to confirm our findings on a larger cohort of patients, with a longer follow up period, analyzing not only carotid plaques, but also the occurrence of major cardiovascular events,” concluded Dr. Sacré.

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