Risk Factors in Cardiovascular Disease in Systemic Lupus Erythematosus

Cardiovascular events (CVEs) are prevalent in patients with systemic lupus erythematosus (SLE), and it is the young women who are disproportionately at risk. The risk factors for accelerated cardiovascular disease remain unclear, with multiple studies producing conflicting results. In this paper, we aim to address both traditional and SLE-specific risk factors postulated to drive the accelerated vascular disease in this cohort. We also discuss the more recent hypothesis that adverse pregnancy outcomes in the form of maternal–placental syndrome and resultant preterm delivery could potentially contribute to the CVEs seen in young women with SLE who have fewer traditional cardiovascular risk factors. The pathophysiology of how placental-mediated vascular insufficiency and hypoxia (with the secretion of placenta-like growth factor (PlGF) and soluble fms-tyrosine-like kinase-1 (sFlt-1), soluble endoglin (sEng) and other placental factors) work synergistically to damage the vascular endothelium is discussed. Adverse pregnancy outcomes ultimately are a small contributing factor to the complex pathophysiological process of cardiovascular disease in patients with SLE. Future collaborative studies between cardiologists, obstetricians, obstetric physicians and rheumatologists may pave the way for a better understanding of a likely multifactorial aetiological process.

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Imaging Assessment of Cardiovascular Disease in Systemic Lupus Erythematosus

Clinical and Developmental Immunology ◽

10.1155/2012/694143 ◽

2012 ◽

Vol 2012 ◽

pp. 1-7 ◽

Cited By ~ 14

Author(s):

Sara C. Croca ◽

Anisur Rahman

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Cardiovascular Disease ◽

Cardiovascular Risk ◽

Lupus Erythematosus ◽

Current Status ◽

Systemic Lupus ◽

Cardiovascular Morbidity And Mortality ◽

Increased Risk ◽

Cardiovascular Assessment

Systemic lupus erythematosus is a multisystem, autoimmune disease known to be one of the strongest risk factors for atherosclerosis. Patients with SLE have an excess cardiovascular risk compared with the general population, leading to increased cardiovascular morbidity and mortality. Although the precise explanation for this is yet to be established, it seems to be associated with the presence of an accelerated atherosclerotic process, arising from the combination of traditional and lupus-specific risk factors. Moreover, cardiovascular-disease associated mortality in patients with SLE has not improved over time. One of the main reasons for this is the poor performance of standard risk stratification tools on assessing the cardiovascular risk of patients with SLE. Therefore, establishing alternative ways to identify patients at increased risk efficiently is essential. With recent developments in several imaging techniques, the ultimate goal of cardiovascular assessment will shift from assessing symptomatic patients to diagnosing early cardiovascular disease in asymptomatic patients which will hopefully help us to prevent its progression. This review will focus on the current status of the imaging tools available to assess cardiac and vascular function in patients with SLE.

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Cardiovascular disease in systemic lupus erythematosus

Rheumatology and Immunology Research ◽

10.2478/rir-2021-0022 ◽

2021 ◽

Vol 2 (3) ◽

pp. 157-172

Author(s):

Maureen McMahon ◽

Richard Seto ◽

Brian J. Skaggs

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Cardiovascular Disease ◽

Lupus Erythematosus ◽

Cardiovascular Events ◽

Subclinical Atherosclerosis ◽

Cardiac Risk ◽

Systemic Lupus ◽

Cardiac Risk Factors ◽

Increased Risk

Abstract There is a well-known increased risk for cardiovascular disease that contributes to morbidity and mortality in systemic lupus erythematosus (SLE). Major adverse cardiovascular events and subclinical atherosclerosis are both increased in this patient population. While traditional cardiac risk factors do contribute to the increased risk that is seen, lupus disease-related factors, medications, and genetic factors also impact the overall risk. SLE-specific inflammation, including oxidized lipids, cytokines, and altered immune cell subtypes all are likely to play a role in the pathogenesis of atherosclerotic plaques. Research is ongoing to identify biomarkers that can help clinicians to predict which SLE patients are at the greatest risk for cardiovascular disease (CVD). While SLE-specific treatment regimens for the prevention of cardiovascular events have not been identified, current strategies include minimization of traditional cardiac risk factors and lowering of overall lupus disease activity.

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Adipokines and Systemic Lupus Erythematosus: Relationship with Metabolic Syndrome and Cardiovascular Disease Risk Factors

The Journal of Rheumatology ◽

10.3899/jrheum.080503 ◽

2009 ◽

Vol 36 (2) ◽

pp. 295-297 ◽

Cited By ~ 72

Author(s):

MARTA VADACCA ◽

DOMENICO MARGIOTTA ◽

AMELIA RIGON ◽

FABIO CACCIAPAGLIA ◽

GIUSY COPPOLINO ◽

...

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Cardiovascular Disease ◽

Metabolic Syndrome ◽

Lupus Erythematosus ◽

Disease Risk ◽

Activity Index ◽

Cardiovascular Disease Risk ◽

Systemic Lupus ◽

The Metabolic Syndrome

Objective.To study concentrations of adipokines in patients with systemic lupus erythematosus (SLE) and the relationship among adipokines, the metabolic syndrome (MeS), and cardiovascular disease (CVD) risk factors.Methods.We enrolled 50 SLE patients and 26 controls, all women. Leptin, resistin, visfatin, and adiponectin were measured by commercial ELISA kits.Results.MeS prevalence was increased among subjects with SLE. Leptin levels were higher in patients with SLE than controls. Among SLE patients, independent determinants of leptin were insulin levels (p < 0.0001), triglycerides (p = 0.03), body mass index (p = 0.02), corticosteroid dosage (p = 0.02), and SLE Disease Activity Index (p = 0.005). Other adipokines did not differ between SLE patients and controls.Conclusion.Leptin was increased in SLE patients and could play a role in SLE-related cardiovascular diseases.

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Cardiovascular Disease in Systemic Lupus Erythematosus: The Role of Traditional and Lupus Related Risk Factors

Current Cardiology Reviews ◽

10.2174/157340308784245775 ◽

2008 ◽

Vol 4 (2) ◽

pp. 116-122 ◽

Cited By ~ 33

Author(s):

Carlos Zeller ◽

Simone Appenzeller

Keyword(s):

Risk Factors ◽

Systemic Lupus Erythematosus ◽

Cardiovascular Disease ◽

Lupus Erythematosus ◽

Systemic Lupus ◽

Related Risk

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Cardiovascular Disease in Latin American Patients with Systemic Lupus Erythematosus: A Cross-Sectional Study and a Systematic Review

Autoimmune Diseases ◽

10.1155/2013/794383 ◽

2013 ◽

Vol 2013 ◽

pp. 1-20 ◽

Cited By ~ 5

Author(s):

Jenny Amaya-Amaya ◽

Juan Camilo Sarmiento-Monroy ◽

Julián Caro-Moreno ◽

Nicolás Molano-González ◽

Rubén D. Mantilla ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Systemic Lupus Erythematosus ◽

Cardiovascular Disease ◽

Latin American ◽

Lupus Erythematosus ◽

Coffee Consumption ◽

Independent Effect ◽

Systemic Lupus ◽

Cross Sectional

Objective. This study was performed to determine the prevalence of and associated risk factors for cardiovascular disease (CVD) in Latin American (LA) patients with systemic lupus erythematosus (SLE).Methods. First, a cross-sectional analytical study was conducted in 310 Colombian patients with SLE in whom CVD was assessed. Associated factors were examined by multivariate regression analyses. Second, a systematic review of the literature on CVD in SLE in LA was performed.Results. There were 133 (36.5%) Colombian SLE patients with CVD. Dyslipidemia, smoking, coffee consumption, and pleural effusion were positively associated with CVD. An independent effect of coffee consumption and cigarette on CVD was found regardless of gender and duration of disease. In the systematic review, 60 articles fulfilling the eligibility criteria were included. A wide range of CVD prevalence was found (4%–79.5%). Several studies reported ancestry, genetic factors, and polyautoimmunity as novel risk factors for such a condition.Conclusions. A high rate of CVD is observed in LA patients with SLE. Awareness of the observed risk factors should encourage preventive population strategies for CVD in patients with SLE aimed at facilitating the suppression of cigarette smoking and coffee consumption as well as at the tight control of dyslipidemia and other modifiable risk factors.

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