Risk Factors for Clots in Patients With Antiphospholipid Syndrome
Risk Factors for Clots in Patients With Antiphospholipid Syndrome
Rodrigues CE, Bonfà E, Caleiro MT, et al
Arthritis Care Res (Hoboken). 2012;64:1576-1583
Most clots seen in the antiphospholipid syndrome (APS) are venous; however, a proportion of clots can be arterial, leading to significant morbidity and mortality. Furthermore, arterial vascular disease in APS can be more difficult to treat. The metabolic syndrome consists of increased visceral fat and insulin resistance, and is a risk factor for arterial cardiovascular disease.
Because both of these diseases affect arterial health, Rodrigues and colleagues investigated the relationship between the metabolic syndrome and arterial events in patients with APS.
Rodrigues and colleagues evaluated 71 patients with primary APS and 73 matched control patients for the presence of the metabolic syndrome, defined as a waist circumference > 80 cm in women and > 90 cm in men, and 2 of the following:
Approximately 55% of the patients with APS had an arterial event (67% stroke, 23% peripheral artery occlusion, 21% angina, and 3% myocardial infarction). Among the patients with APS, 34% were classified as having the metabolic syndrome compared with 7% of matched control patients without APS. Furthermore, patients with APS and the metabolic syndrome had a significantly increased risk for arterial events compared with patients with APS without the metabolic syndrome (79% vs 43%; P = .003). Of note, corticosteroid use among the patients with APS was not assessed.
The investigators concluded that the presence of the metabolic syndrome in patients with APS can aggravate existing arterial abnormalities.
The primary treatment for patients with APS is anticoagulation (typically with warfarin) and the addition of an antiplatelet agent if arterial clotting has occurred. Even with this approach, arterial clots in patients with APS can be difficult to manage. Because the metabolic syndrome is also associated with endothelial injury and arterial disease, identifying and managing this syndrome in patients with APS could improve outcomes.
A take-home point from this study is that the metabolic syndrome is associated with worse arterial disease in patients with APS. Given the potential benefits of treating metabolic syndrome on overall health, and in cardiovascular disease in particular, it is reasonable to manage the metabolic syndrome in patients with APS. Of importance, statins can improve outcomes in both syndromes,and hydroxychloroquine has been associated with reduced risk for clotting in APS and improved glycemia in patients with rheumatoid arthritis or systemic lupus erythematosus; thus, these 2 agents might have particular benefit in patients with APS and the metabolic syndrome. However, additional research is needed to determine whether identification and management of the metabolic syndrome leads to improved long-term outcomes related to arterial (or venous) disease in patients with APS.
Abstract
Association of Arterial Events With the Coexistence of Metabolic Syndrome and Primary Antiphospholipid Syndrome
Rodrigues CE, Bonfà E, Caleiro MT, et al
Arthritis Care Res (Hoboken). 2012;64:1576-1583
Antiphospholipid Syndrome and Metabolic Syndrome
Most clots seen in the antiphospholipid syndrome (APS) are venous; however, a proportion of clots can be arterial, leading to significant morbidity and mortality. Furthermore, arterial vascular disease in APS can be more difficult to treat. The metabolic syndrome consists of increased visceral fat and insulin resistance, and is a risk factor for arterial cardiovascular disease.
Because both of these diseases affect arterial health, Rodrigues and colleagues investigated the relationship between the metabolic syndrome and arterial events in patients with APS.
Study Summary
Rodrigues and colleagues evaluated 71 patients with primary APS and 73 matched control patients for the presence of the metabolic syndrome, defined as a waist circumference > 80 cm in women and > 90 cm in men, and 2 of the following:
Fasting glucose level > 100 mg/dL or type 2 diabetes;
Fasting triglyceride level > 150 mg/dL or treatment for hypertriglyceridemia;
High-density lipoprotein (HDL) cholesterol level < 50 mg/dL in women and < 40 mg/dL in men, or treatment for low HDL cholesterol; or
Systolic blood pressure > 130 mm Hg and/or diastolic blood pressure > 85 mm Hg, or treatment for hypertension.
Approximately 55% of the patients with APS had an arterial event (67% stroke, 23% peripheral artery occlusion, 21% angina, and 3% myocardial infarction). Among the patients with APS, 34% were classified as having the metabolic syndrome compared with 7% of matched control patients without APS. Furthermore, patients with APS and the metabolic syndrome had a significantly increased risk for arterial events compared with patients with APS without the metabolic syndrome (79% vs 43%; P = .003). Of note, corticosteroid use among the patients with APS was not assessed.
The investigators concluded that the presence of the metabolic syndrome in patients with APS can aggravate existing arterial abnormalities.
Viewpoint
The primary treatment for patients with APS is anticoagulation (typically with warfarin) and the addition of an antiplatelet agent if arterial clotting has occurred. Even with this approach, arterial clots in patients with APS can be difficult to manage. Because the metabolic syndrome is also associated with endothelial injury and arterial disease, identifying and managing this syndrome in patients with APS could improve outcomes.
A take-home point from this study is that the metabolic syndrome is associated with worse arterial disease in patients with APS. Given the potential benefits of treating metabolic syndrome on overall health, and in cardiovascular disease in particular, it is reasonable to manage the metabolic syndrome in patients with APS. Of importance, statins can improve outcomes in both syndromes,and hydroxychloroquine has been associated with reduced risk for clotting in APS and improved glycemia in patients with rheumatoid arthritis or systemic lupus erythematosus; thus, these 2 agents might have particular benefit in patients with APS and the metabolic syndrome. However, additional research is needed to determine whether identification and management of the metabolic syndrome leads to improved long-term outcomes related to arterial (or venous) disease in patients with APS.
Abstract
