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Cardiovascular disease risk in systemic lupus erythematous: Certainties and controversies
Fabiola Atzeni1, Ignasi Rodríguez-Pintó2, Ricard Cervera2
1Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy.
Insights
Systemic lupus erythematosus (SLE) patients face higher cardiovascular disease risks due to unique factors beyond traditional ones. Early screening and aggressive treatment are crucial for managing this heightened cardiovascular risk in SLE patients.
Area of Science:
- Rheumatology
- Cardiology
- Immunology
Background:
- Systemic lupus erythematosus (SLE) patients exhibit increased cardiovascular morbidity and mortality.
- Endothelial dysfunction, an early marker of atherosclerosis, occurs in SLE even without traditional cardiovascular risk factors.
- Cardiovascular disease in SLE involves both traditional and SLE-specific risk factors, including disease activity and autoantibodies.
Purpose of the Study:
- To review current findings on cardiovascular disease (CVD) in SLE patients.
- To examine potential screening strategies for CVD risk in SLE.
- To discuss aggressive therapeutic strategies for clinical practice.
Main Methods:
- Literature review of studies on cardiovascular disease in systemic lupus erythematosus.
- Analysis of traditional and SLE-specific risk factors for CVD.
- Examination of immune system activation in SLE pathogenesis of CVD.
Main Results:
- Cardiovascular disease risk is significantly elevated in SLE patients.
- SLE-specific factors, including disease activity and immune system activation, contribute to CVD.
- Endothelial dysfunction is a key early mechanism in SLE-related atherosclerosis.
Conclusions:
- Clinicians must recognize the elevated CVD risk in SLE patients.
- Comprehensive screening for cardiovascular risk factors is essential.
- Aggressive management and treatment strategies are necessary for SLE patients with clinical CVD.
Abstract:
Patients with systemic lupus erythematosus (SLE) experience greater cardiovascular morbidity and mortality compared to the general population. It is known that endothelial dysfunction, an early indicator of atherosclerosis development, can arise even without the presence of conventional cardiovascular risk factors. In fact, the risk factors contributing to cardiovascular disease can be classified into traditional risk factors and those uniquely associated with SLE such as disease activity, autoantibodies, etc.Furthermore, the pathogenesis of cardiovascular disease in SLE is linked to the activation of both the innate and adaptive immune systems. Given these findings, it is essential for clinicians to acknowledge the heightened CVD risk in SLE patients, perform comprehensive screenings for cardiovascular risk factors, and implement aggressive treatment strategies for those who exhibit signs of clinical CVD. The aim of this review is to summarize the findings on cardiovascular disease in SLE and to examine potential screening and therapeutic strategies for clinical practice.
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