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Management of cardiovascular disease in patients with systemic lupus erythematosus
Paramarjan Piranavan1, Andras Perl1,2,3
1Department of Medicine, College of Medicine, State University of New York , Syracuse, NY, USA.
Insights
Systemic lupus erythematosus (SLE) significantly increases cardiovascular disease risk. Guidelines are needed for primary and secondary prevention, considering lupus-specific factors beyond traditional scores to reduce mortality.
Area of Science:
- Cardiology
- Rheumatology
- Immunology
Background:
- Systemic lupus erythematosus (SLE) is a recognized risk factor for cardiovascular disease (CVD).
- Premature cardiovascular disease (CAD) and other cardiac issues contribute to significant morbidity and mortality in SLE patients.
- There is a need for specific guidelines for CVD prevention in SLE.
Purpose of the Study:
- To review cardiovascular manifestations in SLE.
- To discuss traditional and lupus-specific risk factors for CVD in SLE.
- To summarize evidence on non-pharmacological and pharmacological prevention and treatment strategies for CVD in SLE.
Main Methods:
- Literature review of cardiovascular manifestations in SLE.
- Analysis of traditional and SLE-specific risk factors.
- Summary of evidence for various treatment modalities, including medications.
Main Results:
- Traditional risk scores (e.g., Framingham) may underestimate CVD risk in SLE.
- Lupus-specific factors like inflammation, immunometabolic changes, and endothelial dysfunction are crucial.
- Hyperlipidemia management and targeting inflammatory pathways show promise.
Conclusions:
- Current risk scores are inadequate for SLE patients.
- Addressing hyperlipidemia and lupus-specific factors is key to reducing mortality.
- Targeting inflammatory pathways holds future potential for CVD prevention in SLE, requiring further research.
Introduction:
SLE is increasingly recognized as an important risk factor for cardiovascular disease. Premature CAD and several other cardiac manifestations are resulting in significant morbidity and premature death among young and older adults. There is a considerable unmet need for developing specific guidelines toward the primary and secondary prevention of cardiovascular disease in SLE patients.
Areas Covered:
The authors describe the prevalence of various cardiovascular manifestations, associated with traditional and lupus-specific risk factors. They summarize the evidence behind various nonpharmacological and pharmacological options such as cardiac medications, antimalarials, anti-inflammatory, and immunosuppressant medications.
Expert Opinion:
There is considerable literature claiming that the traditional Framingham score used to calculate the risk in the general population would not clearly predict the 10-year risk among SLE patients as they do not include lupus-specific risk factors such as accelerated inflammation, immunometabolic changes, thrombosis, vasospasm, vasculitis, and endothelial dysfunction into account. Identifying potential risk factors among SLE patients and treating hyperlipidemia regardless of their risk scores may be the first step in reducing mortality. Blocking lupus-specific inflammatory pathways by targeting validated biomarkers of pathogenesis has great future potential and more studies are needed on their cardiovascular benefits.
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