Study Looks at the Deadly Combination of Lupus and Cardiac Disease

Newswise — COLUMBUS, Ohio. Suspecting that there may be unidentified mechanisms at work that make lupus a greater risk factor for heart disease than smoking, two researchers at The Ohio State University Wexner Medical Center are capturing images of a beating heart during a lupus “flare” to help solve the mystery.

People with lupus have a 20 to 50-fold higher rate of cardiac events than a person without lupus, but traditional screening tools are unable to identify or track progressive heart damage caused by the chronic autoimmune disease. Recent clinical trials investigating the use of cardio-protective drugs like statins to reduce that risk haven’t panned out, leading researchers to believe that they may be underestimating the visible – and invisible- inflammation caused by lupus.

“It’s like the cardiac disease process is sped up and magnified in lupus patients. Children and teenagers already show signs of thickened arteries. Women may have their first cardiac event in their 30s,” said Stacy Ardoin, MD, one of the study’s investigators and an assistant professor of internal medicine at Ohio State’s College of Medicine. “There’s something happening at a cellular level that the inflammation is triggering, even when we can’t detect inflammation.”

Lupus is characterized by periods of wellness where the disease is dormant, and periods of illness, when the active disease is called a “flare.” With the help of a K12 award given to her by Ohio State’s Center for Clinical and Translational Science (CCTS), Ardoin is hoping that by getting pictures of a beating heart during a flare she’ll be able to find out what makes the combination of cardiac disease and lupus so deadly. She’s working with Subha Raman, MD, a cardiac imaging pioneer, to capture the images and analyze heart function using a combination of novel imaging technology and biomarkers.

“We’re using magnetic resonance technology specifically designed to look at early and subtle heart muscle changes,” said Raman, a cardiologist at Ohio State’s Wexner Medical Center. “We are also looking at blood markers of lupus disease activity and cardiac injury that may or may not predict the presence of potentially reversible damage that we are picking up with the scan.”

Because of the chronic nature of lupus, the study is designed to look at patients over time, across multiple flares. Over the following year, the researchers will pair the imaging findings with biomarkers to see if they can identify clues that might help clinicians intervene earlier to prevent long term damage and improve outcomes. The team also hopes to find new biomarkers and mechanisms in lupus-related heart disease that will help patients avoid devastating cardiac events and survive longer. Importantly, Raman said there are proactive steps that people with lupus can take now.

“It’s important to note that even though people with lupus are at an increased risk for heart disease, they can still do things to lower their risk like optimize weight, exercise and eliminate tobacco use,” said Raman, who is also the medical director of cardiac magnetic resonance and cardiac computed tomography at Ohio State.

While Ardoin and Raman actually met during their residencies at Ohio State and through collaboration on another grant, the CCTS was instrumental in helping the two pull together this project which tapped into both of their passions. Ardoin noted that CCTS supplied critical recruitment assistance for the study as well as access to the clinical research center and database development. Currently, the study is about half way filled, and Ardoin is hopeful they will reach their recruitment goal of 40 participants within the next several months.

“In 1950, the mortality rate for lupus was 80 percent. Today, ten-year survival is at 90 percent. We’ve certainly gotten better in managing the disease, but the key to have the ability to predict flares, and then target the intervention to minimize the damage. We’re hopeful this study will get us closer to being able to do that,” said Ardoin, who is also a pediatric rheumatologist at Nationwide Children’s Hospital.

Ardoin has spent her career studying lupus in children and adults. She is currently the co-investigator on more than seven clinical trials looking at new treatments and diagnostics. Working with Cincinnati Children’s Hospital, Ardoin is the principal investigator for a 2012-2013 Lupus Foundation of America National Research Program-funded study looking at whether levels of microRNA in the urine can indicate lupus nephritis-related disease activity and damage in the kidneys of children with lupus. In addition, along with Wael Jarjour, MD, director of the Division of Rheumatology and Brad Rovin, MD, director of the Division of Nephrology at Ohio State, Ardoin has created the Lupus, Vasculitis, and Glomerulonephritis Registry and Biorepository, one of few in the nation, to be established in order to discover biomarkers that identify lupus nephritis flares.

Systemic lupus erythematosus (SLE or lupus) is a chronic inflammatory autoimmune disease that impacts the entire body, but especially affects the skin, kidneys, lungs, blood, joints, brain and heart. Lupus is characterized by periods of activity (flares) and periods of remission. According to the Lupus Foundation of America, for most people with lupus, proper treatment can minimize symptoms, reduce inflammation and pain, and stop the development of serious organ damage. The disease can start at any age, but is most common in female minority populations, and 90 percent of people with lupus are women. It is estimated that 1.5 million people in the United States have lupus. The disease is more severe in children.

For more information on Ardoin’s current lupus studies or the Lupus registry and biorepository, please visit http://internalmedicine.osu.edu/rheumatology/research/.

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About The Ohio State University Center for Clinical and Translational ScienceDedicated to turning the scientific discoveries of today into the life-changing health innovations of tomorrow, The Ohio State University Center for Clinical and Translational Science (CCTS) is a collaboration of experts including scientists and clinicians from six Ohio State Health Science Colleges, Ohio State’s Wexner Medical Center and College of Medicine, and Nationwide Children’s Hospital. Funded by a multi-year Clinical and Translational Science Award (CTSA) from the National Institutes of Health, OSU CCTS provides financial, organizational and educational support to biomedical researchers as well as opportunities for community members to participate in credible and valuable research. The CCTS is led by Rebecca Jackson, M.D., Director of the CCTS and associate dean of research at Ohio State. For more information, visit http://ccts.osu.edu.

The Ohio State University Center for Clinical and Translational Science (CCTS) is funded by the National Institutes of Health (NIH) Clinical and Translational Science Award (CTSA) program (grants 8UL1TR000090-05, 8KL2TR000112-05, and 8TL1TR000091-05) The CTSA program is led by the NIH’s National Center for Advancing Translational Sciences (NCATS). The content of this release is solely the responsibility of the CCTS and does not necessarily represent the official views of the NIH.