Demographics and disease-related data of systemic lupus erythematosus patients

Demographic and disease-related characteristics of the 186 patients with SLE included in this study are shown in Table 1. Most of them were women (95%), and the mean age ± SD was 50 ± 11 years. The body mass index of the participants was 27 ± 5 kg/m2, and the average abdominal circumference was 92 ± 13 cm. Classic CV risk factors were not uncommon. For example, 17% of the patients were current smokers, 28% had hypertension, and 26% were obese. Likewise, 24% of the patients were taking statins (mostly simvastatin 20 mg/day and atorvastatin 10 mg/day), and 26% and 35% were under aspirin or antihypertensive treatment, respectively. The lipid profile values of patients with SLE are shown in Table 1. Cholesterol was 200 ± 38 mg/dl, and LDL and HDL cholesterol were, respectively, 111 ± 29 and 63 ± 21 mg/dl. Apolipoprotein C3 median serum levels in SLE patients were 1.75 (IQR 1.24–2.59) mg/dl.

Table 1 Characteristics of the SLE patients

Disease duration was 17 ± 9 years. Most of the patients with SLE were in the categories of no activity (39%) or mild-moderate activity (48%) as shown by the SLEDAI scores. SLICC and Katz indexes were 1 (IQR 0–2) and 2 (IQR 1–3), respectively. Seventy-three percent of the patients had a SLICC/ACR DI score equal to or higher than 1. Half of the patients (51%) were taking prednisone. The median daily dose of prednisone was 5 mg/day (IQR 5–7.5 mg). At the time of recruitment, 52% patients were found to be positive for anti-DNA, and 34% were positive for ENA, with anti-Ro being the antibody most frequently found (33%). Disease-modifying antirheumatic drug use was reported in 77% of the patients and 68% were taking hydroxychloroquine when the study was performed (median dose 200 [IQR 200–300] mg/day). Other less used disease-modifying antirheumatic drugs were methotrexate (11%) and azathioprine (13%). Additional information of SLE-related data is shown in Table 1.

Univariable analysis of the relationship of demographic and disease-related data with serum levels of apolipoprotein C3

The classic CV risk factors were generally significantly and strongly associated with circulating ApoC3. In this sense, being hypertensive and obese or having a superior body mass index and abdominal circumference was all associated with higher serum levels of ApoC3. Additionally, patients taking statins or antihypertensive treatment had elevated serum ApoC3 levels compared to those not taking these therapies (Table 2). Also, while CRP, triglycerides, and atherogenic index were significantly and positively associated with ApoC3, HDL cholesterol and apolipoprotein A1 were negatively related to it.

Table 2 Demographics and disease-related data relation to apolipoprotein C3

Disease duration (beta coef. 0.02 [95% CI 0.00–0.04], mg/dl, p = 0.048) was positively related to ApoC3. Remarkably, SLE scores of disease activity, severity, and damage were all associated with higher serum levels of ApoC3. In this sense, SLICC score, both continuous (beta coef. 0.14 [95% CI 0.06–0.23], p = 0.001) and binary — equal or higher than 1 — (beta coef. 0.46 [95% CI 0.07–0.85], p = 0.020), was related to a superior circulating ApoC3. Similarly, the Katz index was significantly and positively associated with higher serum levels of ApoC3 (beta coef. 0.10 [95% CI 0.01–0.19], p = 0.030). Also, patients included in the mild or moderate (beta coef. 0.39 [95% CI 0.03–0.75], p = 0.035), or in the high or very high (beta coef. 0.69 [95% CI 0.02–1.37], p = 0.045) SLEDAI categories were associated with greater ApoC3 levels when compared to those included in the remission category. All the aforementioned relations were found in an univariable manner (Table 2). Other disease-related characteristics like ANA profile, antiphospholipid autoantibodies, complement serum levels, or disease-modifying antirheumatic drugs used in the disease were not associated with circulating ApoC3.

Multivariable analysis of the relationship of SLE activity, severity, and damage scores with apolipoprotein C3

SLICC, SLEDAI, and Katz scores were not related to any of the lipid profile molecules in patients with SLE. In this sense, univariable regression analysis did not yield any significant association between those scores and cholesterol, triglycerides, apolipoproteins, lipoprotein (a), or atherogenic index (Table 3). However, SLICC (beta coef. 0.10 [95% CI 0.02–0.19] mg/dl, p = 0.020), Katz index (0.10 [95% CI 0.02–0.19], p = 0.015), and SLEDAI score (beta coef. 0.04 [95% CI 0.00–0.07], p = 0.036) were significantly associated with higher circulating ApoC3 after multivariable adjustment that included age, body mass index, systolic blood pressure, and statin use (model #1 in Table 3). The significant association remained stable when we performed another multivariable analysis adjusting for the same variables plus lipids that had a univariable relation to the disease scores inferior to 0.20 (model #2 in Table 3). A representation of this relationship is shown in Fig. 1. It was also the case when scores were stratified in different categories: SLICC (equal to or higher than 1) and SLEDAI (equal to or higher than 1; or no activity, mild or moderate, and high or very high SLEDAI) (Supplementary Table 1).

Table 3 Multivariable analysis of the relationship of SLE activity, severity, and damage scores with apolipoprotein C3
Fig. 1
figure 1

Multivariable representation of SLICC, Katz, and SLEDAI scores relationship with ApoC3

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