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Publication Detail
Cardiovascular disease in SLE: what do patients think about using diet as a therapeutic?
Abstract
Background: Systemic lupus erythematosus (SLE) is an autoimmune disorder characterised by chronic inflammation and increased cardiovascular risk (CVR). We hypothesised that diet could be used as a therapeutic strategy to control blood lipid levels, to reduce CVR and potentially control disease symptoms. The primary objective of this study was to investigate the lipid profile of SLE patients to identify lipids associated with disease activity and CVR. The secondary objective was to learn about lupus patient experiences with diet including their opinion on considering diet as a therapeutic option. Methods: Analysis of 220 metabolic biomarkers including 14 lipoprotein subtypes and compositions was performed on serum from 35 SLE patients. A lay summary and a 15 question diet-based online survey were publicly available for 3 weeks; social media was used to promote the survey through relevant charities, hospitals and research groups. Results: High disease activity was associated with increased levels of atherogenic circulating blood lipids (very low, intermediate and low density lipoproteins; VLDL (p = 0.0133), IDL (p = 0.001) and LDL (p = 0.0028) respectively) and decreased athero-protective circulating blood lipids (high density lipoproteins; HDL (p = 0.0488)). Unsupervised hierarchical clustering based on circulating blood lipid levels stratified SLE patients into three distinct groups, each with a unique metabolic and clinical profile. In particular, SLE patients in Group 1 (High VLDL, low HDL) had increased disease activity and markers associated with CVR including increased ApoB: A1 ratios (p < 0.0001) and increased expression of lipids associated with pre-clinical atherosclerotic plaque in adult SLE patients including triglycerides: phosphoglycerides ratios (p = 0.002). Thus a subset of patients with elevated VLDL had more active disease and increased markers associated with CVR. An online survey was used to assess whether SLE patients would be willing to consider modifying their diet depending on their blood lipid levels. 284 responses were received. Patients reported that there was a lack of clinical counselling regarding diet with only 24% of patients stating that their doctor had spoken to them about diet. Despite this, 100% of patients stated that they would change their diet if they knew it would help their symptoms and 83% would take part in a diet-based clinical trial. Text analysis of patient research suggestions identified an interest in using diet to manage fatigue and disease activity. Conclusion: Differences in lipid metabolism in SLE contribute to disease pathogenesis and severity. These profiles are associated with altered lipoprotein lipid transport which can be used to stratify patients into CVR groups. Regulation of lipid metabolism through diet may therefore have therapeutic benefit for specific subgroups of SLE patients. The survey provided evidence that patients support further research and potential diet intervention studies investigating the effect of diet on the symptoms of lupus.
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Inflammation
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Div of Medicine
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Metabolism & Experi Therapeutics
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Inflammation
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