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Original research
Atherosclerosis in SLE: a potential role for serum parathormone levels
  1. Mayra Giannelou1,2,
  2. Charalampos Skarlis3,
  3. Aikaterini Stamouli4,
  4. Eleni Antypa5,
  5. Haralampos M Moutsopoulos6 and
  6. Clio P Mavragani3,7
  1. 1Department of Rheumatology, Peripheral General Hospital Athens Georgios Gennimatas, Athens, Greece
  2. 2Department of Pathophysiology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
  3. 3Department of Physiology, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
  4. 4Peripheral General Hospital Athens Georgios Gennimatas, Athens, Greece
  5. 5Department of Radiology, Peripheral General Hospital Athens Georgios Gennimatas, Athens, Greece
  6. 6Athens Academy, Chair Medical Sciences/Immunology, Athens, Greece
  7. 7Joint Academic Rheumatology Program, National and Kapodistrian University of Athens School of Medicine, Athens, Greece
  1. Correspondence to Dr Clio P Mavragani; kmauragan{at}


Objective A link between bone metabolism and cardiovascular (CV) disease has been suggested mainly in the general population. In the current study we explored whether altered bone metabolism influence CV risk in patients with SLE.

Methods In 138 consecutive patients with SLE, atherosclerosis was assessed by the presence of plaque and/or arterial wall thickening in carotid/femoral arteries by ultrasound. Bone mineral density (BMD) levels and hip/spinal cord fractures together with classical CV disease and osteoporosis risk factors including serum 25(OH) vitamin D3 and parathormone (PTH) levels were recorded in all patients. Serum osteoprotegerin (OPG) and receptor activator of nuclear factor kappa-Β ligand were quantitated by commercial ELISA. Statistical analysis included both univariate and multivariate models.

Results Abnormal PTH serum concentrations (>65 pg/mL)—but not 25(OH) vitamin D3 serum levels—were identified as a risk factor for both plaque formation and arterial wall thickening in patients with SLE (ORs (95% CIs): 8.2 (1.8 to 37.4) and 3.9 (1.3 to 11.8), respectively). This association remained significant following adjustment for vitamin D3 levels and classical CV risk factors. Moreover, an independent association between osteoporosis with plaque formation and arterial wall thickening was detected following adjustment for total steroid dose, premature menopause and disease duration (ORs (95% CIs): 5.3 (1.1 to 26.2) and 3.5 (1.1 to 11.4), respectively). An inverse correlation between femoral neck BMD values and intima–medial thickness scores was also observed (r: −0.42, p=0.008).

Conclusions These findings further strengthen the concept of shared pathophysiological mechanisms between atherogenesis and altered bone metabolism in autoimmune populations, revealing heightened PTH levels as a potential marker for atherosclerosis among patients with SLE.

  • systemic lupus erythematosus
  • atherosclerosis
  • osteoporosis

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  • Presented at Data from this manuscript have been previously presented in an abstract form

  • Contributors Conception and design: CPM, HMM. Experimental procedure: CS. Administrative support: AS. Provision of patients and controls: HMM, CPM, MG, AS. Collection and assembly of data: MG, CPM, AS. Data analysis and interpretation: CS, MG, CPM. Manuscript drafting: MG, CPM. Final approval of manuscript: all authors.

  • Funding This study was supported by Hellenic Rheumatology Society and Grant code 70/3/11260.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, conduct, reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved by the Ethics Committee of the General Hospital of Athens “G.Gennimatas”.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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