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Cardiovascular disease complications in systemic lupus erythematosus
Alexander Torres1, Ali D Askari, Charles J Malemud
1Department of Medicine, Division of Rheumatic Diseases, University Hospitals Case Medical Center, 2061 Cornell Road, Cleveland, OH 44106-5076, USA.
Insights
Systemic lupus erythematosus (SLE) patients show altered cholesterol metabolism, increasing cardiovascular disease risk. Early intervention with cholesterol-reducing drugs may prevent atherosclerosis progression in SLE.
Area of Science:
- Immunology
- Cardiology
- Rheumatology
Background:
- Systemic lupus erythematosus (SLE) is an autoimmune disease with variable presentation.
- A significant link between SLE and cardiovascular (CV) disease is increasingly recognized.
- CV disease in SLE involves inflammation and altered lipid metabolism.
Purpose of the Study:
- To investigate the relationship between lipid profiles and disease activity in SLE.
- To understand the mechanisms of accelerated atherosclerosis in SLE patients.
- To evaluate the potential benefit of cholesterol-lowering therapies in SLE.
Main Methods:
- Analysis of serum lipid levels, inflammatory markers (ESR, IL-6, TNF-alpha), and SLE disease activity index.
- Assessment of vascular endothelial growth factor (VEGF) and low-density lipoprotein (LDL) cholesterol oxidation.
- Correlation analysis adjusted for demographic and clinical factors.
Main Results:
- Low serum high-density lipoprotein (HDL) correlated with elevated ESR, IL-6, TNF-alpha, and SLE disease activity.
- Increased VEGF was observed in SLE-related CV disease.
- Enhanced LDL uptake and oxidation by monocytes contributed to vascular cholesterol deposition and accelerated plaque formation.
Conclusions:
- Altered cholesterol metabolism and inflammation are key drivers of CV disease in SLE.
- Targeting cholesterol reduction may be crucial for managing atherosclerosis risk in SLE patients.
- Cholesterol-reducing drugs should be considered in SLE standard care, particularly for high-risk individuals.
Abstract:
Systemic lupus erythematosus (SLE) is a highly variable autoimmune disease characterized by aberrant host-immune responses and chronic inflammation. Recently, a strong association between cardiovascular (CV) disease and SLE has emerged. Thus, low serum, high-density lipoprotein strongly correlated with elevated erythrocyte sedimentation rate, IL-6, TNF-alpha and the SLE disease activity index after adjusting for age, gender, race, BMI, insulin sensitivity and any concurrent drug use. In SLE, CV disease is characterized by increased VEGF, which may alter vascular hemostasis and promote neoangiogenesis. Increased low-density lipoprotein-cholesterol and proinflammatory high-density lipoprotein-cholesterol uptake by monocytes together with enhanced low-density lipoprotein-cholesterol oxidation results in the deposition of altered cholesterol forms into the vascular wall. This contributes to precocious and accelerated development of coronary artery plaques. Cholesterol-reducing drugs should be considered in the standard of care of SLE patients, especially in those with an unfavorable CV disease risk profile, which could reduce the probability of atherosclerosis progressing to CV disease or stroke in these patients.
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