Study of Endothelial Dysfunction in Systemic Lupus and Its Role in Heart Disease
Status:
Unknown status
Trial end date:
1969-12-31
Target enrollment:
Participant gender:
Summary
Systemic Lupus Erythematosus is a relatively common autoimmune disease that affects mainly
women.Cardiovascular disease as a result of accelerated atherosclerosis is a major cause of
mortality and morbidity in SLE.Previous research has shown that 35-40% of patients with SLE
have abnormalities of myocardial perfusion even when they have no coronary stenoses on
coronary angiography. The reason for these frequent perfusion abnormalities in the absence of
angiographically significant CAD remains uncertain, but could conceivably result from
endothelial dysfunction. In SLE, coronary endothelial dysfunction could result from the
inflammatory process involved in the SLE disease itself, a finding that could explain the
correlation between disease activity and the development of CAD in these patients.As such
endothelial dysfunction may account for accelerated atherosclerosis and cardiac perfusion
defects (without angiographically significant coronary lesions). We propose to first evaluate
whether endothelial dysfunction occurs in these patients and is more frequent in patients
with myocardial perfusion abnormalities. Endothelial function will be assessed by measuring
flow-mediated brachial artery dilatation. In the 250 patients included in the study we will
correlate endothelial function and myocardial perfusion abnormalities to SLE disease
activity, to its treatment and to the presence of CAD risk factors In a subgroup of patients
(estimated 5 patients) in whom it is clinically indicated, coronary angiography will be
performed in order to assess the presence of significant coronary stenoses (>50%),coronary
artery reserve and coronary endothelial dysfunction. We will then attempt to reverse
abnormalities in endothelial function and myocardial perfusion by therapy with an ACE
inhibitor(Quinapril).Patients with myocardial perfusion abnormalities will be randomised to
receive Medication A(oral Quinapril or Placebo) for 8 weeks, will have all baseline
investigations repeated and then will switch over and receive medication B(Quinapril or
placebo) for a further 8 weeks followed by repeat investigations.