Background:
Accelerated atherosclerosis is widely present in patients with systemic lupus erythematosus.
Objective:
The aim of this review is to analyze the relationship between systemic lupus erythematosus and cardiovascular
diseases, with the emphasis on acute myocardial infarction.
Results:
Various molecular mechanisms triggered by infection/inflammation are responsible for endothelial dysfunction
and development of atherosclerosis at an earlier age. Contributing factor is the cumulative effect of traditional
cardiovascular risk factors interaction with disease related characteristics. Myocardial infarction rates are 2- to 10-fold
higher compared to the general population. Young women have the highest relative risk, however, men carry at least 3-
fold higher risk than women. Coronary involvement varies from normal coronary artery with thrombosis, coronary
microartery vasculitis, coronary arteritis, and coronary atherosclerosis. Typical clinical presentation is observed in men
and older women, while atypical is more frequent in young women. Treatment is guided by the underlying mechanism,
engaging invasive procedures alone, or accompanied with immunosuppressive and/or antiinflammatory therapy. There are
significant gender differences in pathophysiology and clinical presentation. However, they receive the same therapeutic
treatments.
Conclusion:
Systemic lupus erythematosus is a major contributor to atherosclerotic and non-atherosclerotic mechanisms
involved in the development of myocardial infarction, which should be taken into account during therapeutic treatment.
Although Systemic lupus erythematosus per se is a “female” disease, males are at increased cardiovascular risk and worse
outcome.
Method:
We conducted a literature review through PubMed and Cochrane, using key words: SLE, atherosclerosis,
atherothrombosis, coronary artery disease, myocardial infarction, prognosis, sex specifics.
Spontaneous coronary artery dissection as the first presentation of systemic lupus erythematosus