Management of cardiovascular complications in systemic lupus erythematosus

Abstract

Cardiovascular disease (CVD) is a major cause of morbidity and mortality in patients with systemic lupus erythematosus (SLE). Patients with SLE have an excess risk compared with the general population; this is particularly pronounced in younger women with SLE who have an excess risk of over 50-fold compared with population controls. There is a higher prevalence of subclinical atherosclerosis in patients with SLE compared with controls, as demonstrated by a variety of imaging modalities discussed in this review. The causality of the excess risk of CVD and subclinical atherosclerosis is multifactorial in patients with SLE. While traditional risk factors play a role, after controlling for the traditional Framingham risk factors, the excess risk is still 7.5-fold greater than the general population. This review will also cover novel cardiovascular risk factors and some SLEspecific variables that contribute to CVD risk. This review discusses the risk factor modification and the evidence available for treatment of these risk factors in SLE. There have not yet been any published randomized, controlled trials in patients with SLE with respect to CVD risk factor modifications. Thus, the treatment and management recommendations are based largely on published guidelines for other populations at high risk for CVD. Keywordscardiac imaging; cardiovascular disease; cardiovascular risk factors; subclinical atherosclerosis; systemic lupus erythematosusIn the last few decades, the prognosis of patients with systemic lupus erythematosus (SLE) has improved immensely. In the 1950s, the 5-year survival rate for SLE was approximately 50% according to a study performed in Toronto, Canada. Subsequent studies have found 5-year survival rates of 90% in patients with SLE [1]. A bimodal mortality pattern was first described in 1976 by Urowitz et al. in the Toronto Lupus cohort. Septicemia in the setting of high-dose prednisone was identified as an early cause of death in patients with more active SLE. Later in the disease course, death was associated with inactive SLE, long duration of prednisone therapy and myocardial infarction (MI) due to atherosclerotic heart disease [2]. More recent data from a large international cohort revealed a 60% decrease in the standardized all-cause mortality rates (SMR) from 1970-1979 (SMR: 4.9) to 1990. However, the SMR trend for cardiovascular disease (including heart disease, arterial disease and stroke) did not decline from 1970 to 2001 [3]. A Swedish cohort followed from 1964 to 1994 demonstrated similar findings of improved overall survival for patients with SLE over the last two decades, but the risk of cardiovascular death remained (by 1985-1994 NIH Public Access Author ManuscriptInt J Clin Rheumtol. Author manuscript; available in PMC 2010 December 1. Published in final edited form as:Int J Clin Rheumtol. This review will discuss the increased risk of CVD observed in patients with SLE, the role of traditional cardiovascular risk factors, the role of novel risk factors (some of which are lu...

Obesity and Cytokines in Childhood-Onset Systemic Lupus Erythematosus

“…IL-10 has been shown to reduce atherosclerosis and it can be found in atheromatous plaque due to local macrophages production [50]. However, IL-10 is involved in SLE pathogenesis and it is increased in SLE patients with CVD compared to SLE patients without CVD [51, 52]. In our study, we did not observe an association between sera IL-10 levels and obesity.…”

Relation of Carotid Intima-Media Thickness and Plaque With Incident Cardiovascular Events in Women With Systemic Lupus Erythematosus

“…28 However, more active SLE may suggest the need for more or longer glucocorticoid use, and it is unclear if there is a direct relation between glucocorticoid use and CVD or if it is a marker of cumulative disease activity. 29 …”

Blood pressure and renal hemodynamic responses to acute angiotensin II infusion are enhanced in a female mouse model of systemic lupus erythematosus

“…inflammation; angiotensin receptor; autoimmune INFLAMMATION AND IMMUNE SYSTEM dysregulation are recognized as prominent contributors to the development and progression of cardiovascular and renal disease. Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disorder associated with a high risk for the development of renal and cardiovascular disease, which are major causes of mortality in these patients (43). Almost all patients with SLE have at least some evidence of renal damage on biopsy (4, 11), and measures of declining renal function, including elevated serum creatinine and blood urea nitrogen or reduced filtration fraction, are commonly reported (11,20,28).…”