Pro-inflammatory HDL (piHDL) may help predict risk of atherosclerosis (ATH) in patients with systemic lupus erythematosus (SLE). The study found 45% of SLE patients and none of the healthy controls had piHDL. PiHDL was significantly associated with carotid plaque and greatly increased the risk of plaque in SLE patients. Traditional risk factors did not fully explain the risk of ATH in SLE. PiHDL could be a useful marker for predicting ATH risk in SLE patients. Further research is needed to develop new treatments targeting piHDL and risk profiles including piHDL.

1. Atherosclerosis in Systemic Lupus Erythematosus Maureen McMahon, MD, MCR Assistant Professor of Medicine David Geffen School of Medicine UCLA

2. Overall Survival in Lupus has Improved Gabriel, S. et al., Arthritis Rheum 1999;42:46-50. 1950-1979 1980-1992

3. Late Deaths in SLE are due to Heart Disease (Atherosclerosis) Abu-Shakra M, et al. J Rheum. 1995;22:1265–1270. [Evidence Level B]

4. There is an Increased Risk for Atherosclerosis (ATH) in SLE CVA = cerebrovascular accident. Esdaile JM, et al. Arthritis Rheum . 2001;44:2331–2337 [Evidence Level B]; Karrar A, et al. Semin Arthritis Rheum . 2001;30:436–443 [Evidence Level C]; Manzi S, et al. Am J Epidemiol . 1997;145:408–415 [Evidence Level B]; Manzi S, et al. Arthritis Rheum . 1999;42:51–60. [Evidence Level B]

5. Prevalence of ATH Plaque Among Control Subjects and Patients With SLE, According to Decade of Life Roman MJ, et. al. N Engl J Med . 2003;349:2399–2406. [Evidence Level B]  4th 5th 6th  7th Decade of Age P = .009 P = .01 P = .001 P = .08

6. Why do SLE patients have an increased risk of Heart Disease?

7. Patients with SLE Do Have Traditional Cardiac Risk Factors Petri et al. Medicine 1992

8. Traditional Risk Factors Do Contribute to ATH in SLE % of patients with plaque, age adjusted p=0.05 p=0.0001 p=0.07 Maksimowicz-McKinnon et al. J Rheum 2006

9. SLE Disease Activity Influences Standard Lipid Levels Posadas-Romero et al. Arthritis Rheum . 2004;50:160-165 .

15. LDL: the “Bad Cholesterol” LDL Mackness MI et al. Biochem J 1993. Lipids Online 2004 (Baylor) Blood Vessel White Blood Cells: Monocytes White Blood Cell: Macrophage HDL are anti-inflammatory Foam Cell HDL Remove “Bad Cholesterol” HDL Prevent Oxidation of LDL Oxidized LDL PLAQUE

19. 45% of SLE patients have pro-inflammatory HDL

20. Pro-inflammatory HDL may be associated with heart disease 4 patients with a history of heart attack were included (all patients had SLE): All 4 had pro-inflammatory HDL!

23. 86% of SLE patients with ATH have piHDL * Chi-squared or Fisher’s Exact

27. What Can Lupus Patients Do to Decrease Their Risk of Heart Disease?

30. NIH CV Risk Calculator

31. hp2010.nhlbihin.net/atpiii/ calculator .asp

40. Acknowledgements UCLA Rheumatology Bevra Hahn, M.D. Christina Charles, M.D. Jennifer Grossman, M.D. John FitzGerald, M.D., Ph.D. Weiling Chen, M.S. UCLA Cardiology Alan Fogelman, M.D. Mohamad Navab, Ph.D. Cedars-Sinai Medical Center Daniel Wallace, M.D. Michael Weisman, M.D. UCLA Radiology Nagesh Ragavendra, M.D. Funding Organizations Lupus Research Institute Alliance for Lupus Research The Arthritis Foundation