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[Atherosclerosis in systemic lupus erythematosus].

Zoubida Tazi Mezalek1, Hicham Harmouche1, Wafaa Ammouri1

  • 1Université Mohamed V Souissi, faculté de médecine et de pharmacie, Rabat, Maroc; Hôpital Ibn Sina, service de médecine interne, 1000 Rabat, Maroc.

Presse Medicale (Paris, France : 1983)
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Summary

Systemic lupus erythematosus (SLE) patients face higher cardiovascular disease risk due to traditional factors, lupus-specific issues, and treatments like corticosteroids. Managing SLE requires addressing these combined risks for better patient outcomes.

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Area of Science:

  • Rheumatology
  • Cardiology
  • Immunology

Context:

  • Systemic lupus erythematosus (SLE) patients exhibit elevated cardiovascular disease (CVD) risk.
  • Traditional CVD risk factors alone do not fully explain this increased risk in SLE patients.

Purpose:

  • To review the incidence and prevalence of cardiovascular events and subclinical atherosclerosis in SLE.
  • To detail the interplay of traditional, SLE-specific, and treatment-related risk factors.

Summary:

  • Atherosclerosis is more prevalent and occurs earlier in SLE patients, with a significantly higher risk of myocardial infarction.
  • SLE itself is an independent risk factor for subclinical atherosclerosis; over a third of patients show signs like carotid plaques or coronary artery calcifications.
  • Key contributors include traditional risk factors, SLE-specific elements (age at diagnosis, disease activity, renal involvement), lipid abnormalities, and potentially vascular inflammation, oxidative stress, and immune complex activation.
  • Corticosteroids present a dual role, exacerbating metabolic risks while offering anti-inflammatory benefits.
  • Antimalarials show cardioprotective effects, while other immunosuppressants may slow atherosclerosis progression, though their exact roles need further study.
  • Statins currently lack demonstrated significant benefit for cardiovascular risk reduction in SLE patients.

Impact:

  • Highlights the complex multifactorial nature of accelerated atherosclerosis in SLE.
  • Underscores the need for comprehensive management strategies integrating traditional, lupus-specific, and therapy-related factors.
  • Informs clinical practice regarding risk assessment and therapeutic interventions for cardiovascular health in SLE patients.