E62. CARDIOVASCULAR RISK ASSESSMENT AND MANAGEMENT IN PATIENTS WITH SYSTEMIC LUPUS ERYTHEMATOSUS

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.

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Comment on: Beneficial effect of Mediterranean diet on disease activity and cardiovascular risk in systemic lupus erythematosus patients: a cross-sectional study

Rheumatology ◽

10.1093/rheumatology/keab281 ◽

2021 ◽

Author(s):

Yusuke Matsuo ◽

Toshimasa Shimizu ◽

Yoshie Gon ◽

Motohiko Sato ◽

Sho Matsushita ◽

...

Keyword(s):

Systemic Lupus Erythematosus ◽

Cardiovascular Risk ◽

Beneficial Effect ◽

Disease Activity ◽

Mediterranean Diet ◽

Lupus Erythematosus ◽

Cross Sectional Study ◽

Sectional Study ◽

Systemic Lupus ◽

Cross Sectional

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Semiquantified Noncalcified Coronary Plaque in Systemic Lupus Erythematosus

The Journal of Rheumatology ◽

10.3899/jrheum.120197 ◽

2012 ◽

Vol 39 (12) ◽

pp. 2286-2293 ◽

Cited By ~ 14

Author(s):

ADNAN N. KIANI ◽

JENS VOGEL-CLAUSSEN ◽

ARMIN ARBAB-ZADEH ◽

LAURENCE S. MAGDER ◽

JOAO LIMA ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Lupus Erythematosus ◽

Univariate Analysis ◽

Coronary Plaque ◽

Systemic Lupus ◽

History Of ◽

Noncalcified Plaque

Objective.A major cause of morbidity and mortality in systemic lupus erythematosus (SLE) is accelerated coronary atherosclerosis. New technology (computed tomographic angiography) can measure noncalcified coronary plaque (NCP), which is more prone to rupture. We report on a study of semiquantified NCP in SLE.Methods.Patients with SLE (n = 147) with no history of cardiovascular disease underwent 64-slice coronary multidetector computed tomography (MDCT). The MDCT scans were evaluated quantitatively by a radiologist, using dedicated software.Results.The group of 147 patients with SLE was 86% female, 70% white, 29% African American, and 3% other ethnicity. The mean age was 51 years. In our univariate analysis, the major traditional cardiovascular risk factors associated with noncalcified plaque were age (p = 0.007), obesity (p = 0.03; measured as body mass index), homocysteine (p = 0.05), and hypertension (p = 0.04). Anticardiolipin (p = 0.026; but not lupus anticoagulant) and anti-dsDNA (p = 0.03) were associated with higher noncalcified plaque. Prednisone and hydroxychloroquine therapy had no effect, but methotrexate (MTX) use was associated with higher noncalcified plaque (p = 0.0001). In the best multivariate model, age, current MTX use, and history of anti-dsDNA remained significant.Conclusion.Our results suggest that serologic SLE (anti-dsDNA) and traditional cardiovascular risk factors contribute to semiquantified noncalcified plaque in SLE. The association with MTX is not understood, but should be replicated in larger studies and in multiple centers.

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Monitoring patients with systemic lupus erythematosus: general characteristics and discussion questions (according to the Canadian Rheumatology Association recommendations)

Rheumatology Science and Practice ◽

10.14412/1995-4484-2019-255-264 ◽

2019 ◽

Vol 57 (3) ◽

pp. 255-264 ◽

Cited By ~ 1

Author(s):

T. A. Panafidina ◽

T. V. Popkova ◽

S. K. Solovyev

Keyword(s):

Systemic Lupus Erythematosus ◽

Lupus Erythematosus ◽

Carotid Arteries ◽

Damage Index ◽

Cardiovascular Risk Assessment ◽

Systemic Lupus ◽

Assessment Development ◽

Viral Hepatitis B ◽

First Time

The paper details 15 new recommendations of the Canadian Rheumatology Association for the clinical monitoring of patients with systemic lupus erythematosus (SLE). During their development, the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) classification system for rating the quality of recommendations was used for the first time. The recommendations for physician specialization; cardiovascular risk assessment; anti-Ro/SSA and anti-La/SSB antibody concentrations examination during pregnancy; and annual influenza vaccination are considered to be strong; those for rating disease activity and damage index; ultrasound of the carotid arteries; diagnosis of osteoporosis and osteonecrosis; Doppler ultrasound of uterine and fetoplacental blood flow during pregnancy; screening for cervical cancer, viral hepatitis B and C in patients with SLE are regarded as conditional.

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