Effects of promoting a healthy lifestyle in patients with systemic lupus erythematosus on cardiovascular risk: the randomized controlled clinical trial Living well with lupus

Author(s)

Sofia Mendes Sieczkowska

• Document type: Doctoral Thesis
• Press: São Paulo.
• Institution: Universidade de São Paulo (USP). Faculdade de Medicina (FM/SBD)
• Defense date: 2023-04-25

Examining board members

Bruno Gualano; Fabiana Braga Benatti; Fernanda Rodrigues Lima

• Advisor: Bruno Gualano

Abstract

Systemic lupus erythematosus (SLE) is an autoimmune rheumatic disease characterized by a variety of symptoms, such as skin lesions, arthritis, kidney disorders, neurological disorders, or hematological changes. Patients with SLE have a high prevalence of cardiovascular diseases, which are the main causes of morbidity and mortality in the disease. Lifestyle interventions (physical activity and nutritional interventions) are non-pharmacological strategies that have great potential to improve the cardiovascular health of these patients. Thus, the aim of the present study was to investigate the effects of a lifestyle intervention on cardiometabolic risk factors in patients with SLE. The patients were randomly allocated into two groups: intervention group or control group. The intervention lasted for 6 months, focusing on lifestyle change, through personalized recommendations for physical activity (structured and non-structured) and changes in dietary consumption and structure. Before and after the intervention, the following assessments were performed: (1) cardiometabolic risk score (primary outcome), (2) anthropometry and visceral fat, (3) aerobic capacity, (4) blood pressure, (5) blood collections, (6) blood flow and endothelial function, and (7) physical activity level and dietary consumption. In the intention-to-treat analysis, there was no significant interaction between group and time in cardiovascular risk parameters, body composition, cardiometabolic factors, inflammatory markers, oxidative stress markers, cardiopulmonary exercise test parameters, and endothelial function. There was an interaction in the inflammatory marker erythrocyte sedimentation rate (ESR), but no significant difference was observed in post hoc analysis (estimate mean difference (EMD): 2.20; 95%CI: -12.62 to 8.20; p=0.94). In the per-protocol analysis, there was no significant difference in the interaction between group and time in most parameters, except for the interaction in body mass index (BMI) and ESR, but both outcomes did not maintain significant differences in post hoc analysis [BMI (EMD: 0.80; 95%CI: -1.62 to 3.22; p=0.81); ESR (EMD: -1.69; 95%CI: -12.57 to 9.18; p=0.97)]. There were no differences observed when analyzing adherent and non-adherent subgroups. It can be concluded that after 24 weeks of a lifestyle intervention in patients with SLE, no significant differences were observed in the interaction of the primary and secondary outcomes (AU)

• FAPESP's process: 19/15231-4 - Promotion of healthy lifestyle in patients with Systemic Erythematosus Lupus: effects on cardiometabolic risks factors the randomized and controlled clinical trial living well with Lupus
• Grantee: Sofia Mendes Sieczkowska
• Support Opportunities: Scholarships in Brazil - Doctorate