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Therapy Insight: systemic lupus erythematosus as a risk factor for cardiovascular disease

Nature Clinical Practice Cardiovascular Medicine volume 2, pages 423–430 (2005)Cite this article

Abstract

Systemic lupus erythematosus (SLE) is a multisystem autoimmune disease with a strong female predilection. Cardiovascular morbidity and mortality is a frequent complication, particularly in females aged 35–44 years, in whom the risk of myocardial infarction is raised 50-fold. The mechanisms underlying this increased risk are not fully understood. Certain traditional risk factors, such as hypertension and diabetes mellitus, are more common in SLE patients than in the general population. These factors do not, however, completely account for the increased cardiovascular risk; factors such as renal impairment, increased homocysteine levels and early menopause probably have a role. In addition, several factors more-specifically related to lupus are proposed to be of importance, including chronic inflammation, antiphospholipid antibodies and therapy, especially corticosteroid use. Thus, we need to be proactive in our approach to risk-factor management in SLE patients. Here, we propose that, like diabetes mellitus, SLE should be considered a coronary heart disease equivalent condition for baseline risk and that assessment of cardiovascular risk should be done routinely. In addition to lifestyle modifications, blood pressure and cholesterol levels should be stringently controlled, and administration of aspirin should be considered in selected patients. The increased use of certain interventions, such as statins, also needs to be more-widely investigated in this population.

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Figure 1: Schematic summary of atherosclerosis development emphasizing the inflammatory nature of the process.

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Acknowledgements

We acknowledge the support of the Ontario Lupus Association (Geoff Carr Lupus Fellowship), The Heart and Stroke Foundation of Ontario, The Arthritis Research Campaign (UK), Lupus UK, The Wellcome Trust and the charitable funds of Central Manchester and Manchester Children's University Hospital NHS Trust.

Author information

Authors and Affiliations

  1. North-West England Deanery Rheumatology Training Programme,

    Sahena Haque & Ian N Bruce

  2. Arthritis Research Campaign Epidemiology Unit and Rheumatism Research Centre, University of Manchester, and Central Manchester and Manchester Children's University Hospitals, UK

    Sahena Haque & Ian N Bruce

Authors
  1. Sahena Haque
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Corresponding author

Correspondence to Ian N Bruce.

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Glossary

SINGLE PHOTON EMISSION COMPUTED TOMOGRAPHY–DUAL ISOTOPE MYOCARDIAL PERFUSION IMAGING (SPECT-DIMPI)

A nuclear cardiac imaging technique where the resting and stress images are acquired using different isotopes (201Tl and 99mTc–sestamibi)

B-MODE DOPPLER ULTRASOUND

A vascular imaging technique used to examine the carotid and/or femoral artery: the ultrasound image is acquired using the Brightness (B) mode, and the Doppler technique allows examination of blood flow characteristics

ANTIPHOSPHOLIPID ANTIBODIES (aPL)

Antibodies directed against negatively charged phospholipids

ANTIPHOSPHOLIPID SYNDROME (APS)

A clinical syndrome of thrombosis (arterial or venous) and/or recurrent miscarriage in the presence of antiphospholipid antibodies and/or the lupus anticoagulant

β2 GLYCOPROTEIN I

Also known as apolipoprotein H, it is a cofactor in the binding of pathogenic antiphospholipid antibodies

MACROPHAGE SCAVENGER RECEPTORS

Membrane glycoproteins that mediate the uptake and endocytosis of a range of extracellular macromolecules including oxidatively modified LDL

FC RECEPTORS

Membrane receptors for the Fc portion of immunoglobulin molecules

PASSIVE ADMINISTRATION OF ANTIBODIES

Transfer of antibodies directly into an organism rather than generating them in the host by exposure to antigens

COMPLEMENT CASCADE

A constitutive, nonspecific protein cascade important in host defense, which makes bacteria susceptible to phagocytosis by lysing bacterial cell walls and activating other host defense systems

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Haque, S., Bruce, I. Therapy Insight: systemic lupus erythematosus as a risk factor for cardiovascular disease. Nat Rev Cardiol 2, 423–430 (2005). https://doi.org/10.1038/ncpcardio0270

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