News Release

New biomarkers for cardiovascular risk in patients with juvenile-onset systemic lupus erythematosus (JSLE)

ApoB:A1 ratio and metabolomic lipoprotein signatures identified as new biomarkers for cardiovascular risk in JSLE patients

Peer-Reviewed Publication

European Alliance of Associations for Rheumatology (EULAR)

Annual European Congress of Rheumatology (EULAR 2019)
Madrid, Spain, 12-15 June 2019

Madrid, Spain, 13 June 2019: The results of a study presented today at the Annual European Congress of Rheumatology (EULAR 2019) identify ApoB:A1 ratio and metabolomic lipoprotein signatures as potential biomarkers for cardiovascular risk in patients with juvenile-onset systemic lupus erythematosus (JSLE).1

In depth metabolomics was used to investigate dyslipidaemia and cardiovascular risk in a cohort of patients with JSLE. Unbiased hierarchical clustering stratified patients by metabolomic profile and revealed three distinct groups. Groups One and Two were identified as high and low cardiovascular risk respectively based on their unique lipoprotein profile, immune cell phenotype and clinical presentation. Further analysis identified ApoB:A1 ratio as a highly predictive biomarker distinguishing between these high and low cardiovascular risk groups. Longitudinal analysis revealed that the ApoB:A1 ratio biomarker remained stable over time.1

"Our study identifies ApoB:A1 ratio and metabolomic lipoprotein signatures as potential new biomarkers to predict cardiovascular risk in patients with juvenile-onset SLE," said Dr George Robinson, Senior Research Associate, Centre for Adolescent Rheumatology Versus Arthritis, University College London, London, England. "Patient stratification using these biomarkers could provide an opportunity for tailored disease treatments using lipid modification therapy and lifestyle interventions."

The patients in Group One were identified as high cardiovascular risk due to their lipoprotein profile (decreased high density lipoproteins (HDL) and increased very low and low density lipoproteins (VLDL/LDL)). Group One had a significant increase in plasmablasts and activated T-cells compared to matched healthy controls and had clinical features associated with increased disease activity. These immunopathogenic properties were not seen in the low cardiovascular risk Group Two which also had the opposite lipoprotein profile (increased HDL and decreased VLDL/LDL). Group Three had an intermediate CVR but a pro-inflammatory immune cell profile.1

"Regular assessment for traditional and disease-related risk factors for cardiovascular disease is very important in patients with SLE," said Tanita Wilhelmer, Chair, Young PARE. "We welcome these data to support the identification of those at greatest risk."

This form of risk assessment is particularly important in patients with SLE as they have been found to be twice as likely to suffer from cardiovascular disease. Research shows that SLE patients are between 9- and 50-fold more likely to suffer a myocardial infarction over the general population, and 3-fold more likely to suffer a fatal myocardial infarction.

Systemic lupus erythematosus is an autoimmune disease typically affecting women between the ages of 15 and 50, and symptoms flare up unpredictably. Approximately 20% of cases begin during childhood and in these patients the disease is suggested to be more severe. The risk for certain types of deaths, primarily related to lupus activity (such as renal disease), has decreased over time, while the risk for deaths due to circulatory disease does not appear to have diminished.

The study included a discovery cohort of 35 JSLE patients and 39 age/sex matched healthy donors. Metabolic biomarker analysis and in-depth immune cell phenotyping was performed on the serum and peripheral blood mononuclear cells (PBMCs) taken from the participants. Data were analysed using cluster and correlation-correlation and receiver operating characteristic analysis. The metabolomic patient stratification was validated in a second cohort of 31 JSLE patients.1

Abstract number: OP0148



For further information on this study, or to request an interview with the study lead, please do not hesitate to contact the EULAR Press Office:

Telephone: +44 (0) 20 7438 3084
Twitter: @EULAR_Press

About Rheumatic and Musculoskeletal Diseases

Rheumatic and musculoskeletal diseases (RMDs) are a diverse group of diseases that commonly affect the joints, but can also affect the muscles, other tissues and internal organs. There are more than 200 different RMDs, affecting both children and adults. They are usually caused by problems of the immune system, inflammation, infections or gradual deterioration of joints, muscle and bones. Many of these diseases are long term and worsen over time. They are typically painful and Iimit function. In severe cases, RMDs can result in significant disability, having a major impact on both quality of life and life expectancy.


The European League against Rheumatism (EULAR) is the European umbrella organisation representing scientific societies, health professional associations and organisations for people with RMDs. EULAR aims to reduce the burden of RMDs on individuals and society and to improve the treatment, prevention and rehabilitation of RMDs. To this end, EULAR fosters excellence in education and research in the field of rheumatology. It promotes the translation of research advances into daily care and fights for the recognition of the needs of people with RMDs by the EU institutions through advocacy action.

To find out more about the activities of EULAR, visit:


    1. Robinson G, Radziszewska A, Wincup C, et al. Metabolomics in juvenile-onset SLE: identifying new biomarkers to predict cardiovascular risk. EULAR 2019; Madrid: Abstract OP0148.

    2. Hak A, Karlson E, Feskanich D, et al. Systemic lupus erythematosus and risk of cardiovascular disease Results from the Nurses' Health Study. Arthritis Rheum. 2009;61(10):1396-1402.

    3. Zeller CB and Appenzeller S. Cardiovascular Disease in Systemic Lupus Erythematosus: The Role of Traditional and Lupus Related Risk Factors. Curr Cardiol Rev. 2008 May;4(2):116-122.

    4. Ambrose N, Morgan TA, Galloway J, et al. Differences in disease phenotype and severity in SLE across age groups. Lupus. 2016;25(14):1542-1550.

    5. Bernatsky S, Boivin JF, Joseph L, et al. Mortality in systemic lupus erythematosus. Arthritis Rheum. 2006;54(8):2550-7.

    6. van der Heijde D, Daikh DI, Betteridge N, et al. Common language description of the term rheumatic and musculoskeletal diseases (RMDs) for use in communication with the lay public, healthcare providers and other stakeholders endorsed by the European League Against Rheumatism (EULAR) and the American College of Rheumatology (ACR). Ann Rheum Dis. 2018 Jun;77(6):829-832.

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