Arteriosclerosis obliterans associated with anti-cardiolipin antibody β2-glycoprotein I antibodies as a strong risk factor for ischaemic heart disease in patients with systemic lupus erythematosus

Objective. The main objective of this study was to clarify the role of aPLs in the pathogenesis of arteriosclerosis obliterans (ASO), ischaemic heart disease (IHD) and cerebral vascular disorder (CVD) in patients with SLE. Methods. We evaluated 155 patients with SLE by using objective tests for diagnosing ASO, IHD and CVD and laboratory tests including ELISA for aCL/beta 2-glycoprotein I antibodies (aCL/beta 2-GPI) and anti-phosphatidylserine/prothrombin antibodies (anti-PS/PT). Results. Twenty-five ( 16.1%) of the 155 SLE patients were diagnosed with ASO. Both aCL/beta 2-GPI and anti-PS/PT levels were significantly higher in SLE patients with ASO ( mean +/- S. E.,104.3 +/- 38.8 U/ ml foraCL/beta 2-GPI, P < 0.01; 72.6 +/- 48.9 U/ ml for anti-PS/PT, P < 0.05) than in SLE patients without ASO ( 22.8 +/- 9.9 U/ ml for aCL/beta 2-GPI; 18.3 +/- 4.4 U/ ml for anti-PS/PT). Multivariate logistic analysis including aCL/beta 2-GPI, anti-PS/PT and traditional risk factors ( hypercholesterolaemia, hypertension and diabetes mellitus) confirmed that the presence of aCL/beta 2-GPI was the most significant risk factor for ASO in SLE patients [ odds ratio ( OR) 3.45; 95% CI 1.40, 8.56; P < 0.01]. Furthermore, the prevalence of ASO was associated strongly with IHD ( OR 11.8; 95% CI 3.45, 40.1; P < 0.0001) but not CVD ( OR 1.84; 95% CI 0.65, 5.21; P= 0.25). Conclusions. The presence of aCL/beta 2-GPI contributes to the risk of development of ASO, which may represent an important mechanism for the pathogenesis of IHD in patients with SLE.