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Premature coronary heart disease in SLE: can we prevent progression?
1Division of Rheumatology, Department of Medicine, University of Padova, Italy.
Insights
Systemic lupus erythematosus (SLE) patients face accelerated atherosclerosis and coronary heart disease (CHD) risk. Management requires addressing traditional and non-traditional factors, including lifestyle, disease activity, and specific medications.
Area of Science:
- Cardiovascular Medicine
- Rheumatology
- Immunology
Background:
- Systemic lupus erythematosus (SLE) patients exhibit increased prevalence and accelerated progression of atherosclerosis.
- Coronary heart disease (CHD) is a significant cause of morbidity and mortality in SLE.
- Traditional cardiovascular risk factors are more common in SLE but do not fully explain the heightened atherosclerosis risk.
Purpose of the Study:
- To review the epidemiology of atherosclerosis in SLE.
- To identify traditional and non-traditional risk factors for accelerated atherosclerosis in SLE.
- To outline preventive strategies for CHD in SLE patients.
Main Methods:
- Literature review of studies on atherosclerosis, CHD, and cardiovascular risk factors in SLE patients.
- Analysis of traditional risk factors (hypertension, diabetes, dyslipidemia).
- Identification of non-traditional risk factors (disease activity, damage, treatments).
Main Results:
- SLE patients have higher rates of clinical and subclinical atherosclerosis.
- Accelerated atherosclerosis progression is observed in SLE.
- Non-traditional risk factors, including disease activity and treatments, contribute significantly to cardiovascular risk.
Conclusions:
- Preventive strategies for CHD in SLE are essential.
- Strategies include smoking cessation, physical activity, metabolic management, controlling disease activity, and minimizing corticosteroid exposure.
- Pharmacological interventions like low-dose aspirin, ACE inhibitors, vitamin D, antimalarials, and immunosuppressants may be considered.
Abstract:
Patients with systemic lupus erythematosus (SLE) have a higher prevalence of clinical and subclinical atherosclerosis compared with age- and sex-matched controls. Atherosclerosis progression is also accelerated in SLE, and coronary heart disease (CHD) is a major cause of morbidity and mortality. Traditional cardiovascular (CV) risk factors, including hypertension, diabetes mellitus or dyslipidemia, are more prevalent in SLE patients than in the general population, but they cannot fully account for accelerated atherosclerosis in SLE. In fact, a number of nontraditional risk factors have been identified, including disease activity, damage and various treatments. Preventive strategies for CHD are mandatory in SLE patients and should include giving up smoking; performing regular physical activity; managing metabolic abnormalities such as dyslipidemia, insulin resistance, and diabetes; treating persistent disease activity; and minimizing chronic exposure to corticosteroids. Low-dose aspirin, angiotensin-converting enzyme (ACE) inhibitors, vitamin D supplementation, antimalarials and, when indicated, some immunosuppressants such as mycophenolate mofetil should also be considered.
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