[High cardiovascular complications in systemic lupus erythematosus: physiopathology and risk management]

Area of Science:

• Rheumatology
• Cardiology
• Immunology

Context:

• Cardiovascular disease is the leading cause of mortality in patients with systemic lupus erythematosus (SLE).
• SLE patients face a substantially higher risk of myocardial infarction compared to the general population.
• This elevated risk stems from accelerated atherosclerosis and a prothrombotic state.

Purpose:

• To highlight the dual origins of cardiovascular risk in SLE: traditional risk factors and SLE-specific mechanisms.
• To propose a paradigm shift in managing cardiovascular risk in SLE patients.
• To advocate for integrating SLE as a primary cardiovascular risk factor in clinical practice.

Summary:

• SLE contributes to cardiovascular risk through accelerated atherosclerosis, prothrombotic tendencies, autoantibody-mediated effects on lipids and clotting, endothelial dysfunction, and chronic inflammation.
• Traditional cardiovascular risk factors are more prevalent in SLE patients.
• Current treatment approaches may not fully address the unique cardiovascular challenges posed by SLE.

Impact:

• Recommends considering SLE itself as a comprehensive cardiovascular risk factor for enhanced risk management strategies.
• Suggests modifying current medical practices to incorporate this approach, particularly for younger patients.
• Emphasizes the need for tailored management plans, including optimal targets for traditional risk factors and SLE-specific therapies.