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Systemic Lupus Erythematosus and Endothelial Dysfunction: A Close Relationship.

Edoardo Sciatti1, Ilaria Cavazzana2, Enrico Vizzardi1

  • 1Cardiology Unit, University and ASST Spedali Civili, Brescia, Italy.

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Systemic lupus erythematosus (SLE) patients experience accelerated atherosclerosis due to endothelial dysfunction, increasing cardiovascular disease risk. Early assessment and management of cardiovascular risk factors are crucial for these patients.

Keywords:
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Area of Science:

  • Cardiovascular Medicine
  • Rheumatology
  • Immunology

Background:

  • Systemic lupus erythematosus (SLE) is associated with a 6-fold higher incidence of accelerated atherosclerosis compared to the general population.
  • Accelerated atherosclerosis in SLE stems from complex interactions involving classical and non-classical cardiovascular risk factors.
  • Endothelial dysfunction and arterial stiffness are linked to subclinical and widespread atherosclerosis in SLE patients.

Purpose of the Study:

  • To review and analyze the association between systemic lupus erythematosus (SLE) and endothelial dysfunction.
  • To explore the mechanisms contributing to endothelial dysfunction in SLE.

Main Methods:

  • Literature review and meta-analysis of studies investigating SLE and atherosclerosis.
  • Analysis of proposed mechanisms for endothelial dysfunction in SLE, including immune cell activation and inflammatory markers.

Main Results:

  • Studies indicate a significant prevalence of subclinical accelerated atherosclerosis in SLE patients from childhood compared to controls.
  • Endothelial dysfunction is a key feature contributing to increased cardiovascular risk in SLE.

Conclusions:

  • Endothelial dysfunction in SLE is multifactorial, involving impaired apoptotic cell clearance, oxidative stress, autoantibodies, T cell subtypes, and cytokine cascades.
  • Multidisciplinary management is recommended for early assessment and periodic treatment of cardiovascular risk factors in SLE patients.
  • Further prospective studies are required to validate the benefits of proposed management strategies.