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Published on: June 8, 2022
Cardiovascular disease risk and pathogenesis in systemic lupus erythematosus
Christopher B Oliveira1, Mariana J Kaplan2
1Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, 10 Center Drive, 12N248C, Bethesda, MD, 20892, USA.
Insights
Patients with systemic lupus erythematosus (SLE) face a higher risk of cardiovascular disease (CVD) due to immune dysregulation, not just traditional factors. Understanding these SLE-specific mechanisms is key to preventing heart events and mortality.
Area of Science:
- Immunology
- Cardiology
- Rheumatology
Background:
- Systemic lupus erythematosus (SLE) is associated with significant cardiovascular (CV) comorbidity and mortality.
- The increased CV risk in SLE patients is not fully explained by traditional CV risk factors.
- Immune and inflammatory pathways are implicated in the heightened CV risk observed in SLE.
Purpose of the Study:
- To explore the mechanisms linking SLE to cardiovascular disease (CVD).
- To highlight the role of immune dysregulation in SLE-related CVD.
- To emphasize the need for improved CV risk management in SLE patients.
Main Methods:
- Review of existing literature on SLE and cardiovascular complications.
- Analysis of immunological factors contributing to CVD in SLE.
- Examination of clinical and metabolic features impacting CV risk in SLE.
Main Results:
- SLE involves widespread immune dysregulation, including type I interferon, neutrophil extracellular traps, and autoantibodies.
- These immunological factors contribute to clinical and metabolic changes that increase CVD risk.
- Functional aberrations in immune cells are present in SLE and may influence CVD progression.
Conclusions:
- SLE-specific immunological factors are critical drivers of cardiovascular risk.
- Current understanding necessitates improved screening, monitoring, and targeted therapies for CVD in SLE.
- Further research is ongoing to elucidate pathogenic drivers and develop preventative strategies.
Abstract:
Systemic lupus erythematosus (SLE) often features extensive cardiovascular (CV) comorbidity and patients with SLE are at significantly increased risk of CV event occurrence and CV-related mortality. While the specific mechanisms leading to this increased cardiovascular disease (CVD) risk remain to be fully characterized, this heightened risk cannot be fully explained by traditional CV risk factors and is likely driven by immunologic and inflammatory features of SLE. Widespread innate and adaptive immune dysregulation characterize SLE, and factors including excessive type I interferon burden, inappropriate formation and ineffective clearance of neutrophil extracellular traps, and autoantibody formation have been linked to clinical and metabolic features impacting CV risk in SLE and may represent pathogenic drivers of SLE-related CVD. Indeed, functional and phenotypic aberrations in almost every immune cell type are present in SLE and may impact CVD progression. As understanding of the contribution of SLE-specific factors to CVD in SLE improves, improved screening and monitoring of CV risk alongside development of therapeutic treatments aimed at prevention of CVD in SLE patients are required and remain the focus of several ongoing studies and lines of inquiry.
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