Cardiovascular disease in lupus

Abstract

Purpose of review With improved management of the classical disease manifestations of systemic lupus erythematosus (SLE), cardiovascular disease (CVD) has emerged as one of the most important causes of morbidity and mortality. This review in particular focuses on progress over the past year in clinical and basic aspects of SLE-driven accelerated atherosclerosis. Recent findings Both subclinical CVD and CV events continue to be recognized at increased frequency in previously unstudied lupus cohorts and populations. Novel associations have been identified between lupus CVD and cognitive impairment, depression, and low income status. In terms of pathogenesis, there is an ever-increasing focus on the innate immune system and, in particular, type I interferons (IFNs). Recent studies have drawn connections in both human and murine models between neutrophils, plasmacytoid dendritic cells, type I IFNs, and endothelial dysfunction. Whether treatments such as mycophenolate mofetil or statins have a role in prevention of lupus CVD is an area of intensive study. Summary CVD is a major complication of lupus and is now a leading cause of death among people living with this disease. As such, additional studies are needed in order to identify the most effective preventive strategies and most predictive vascular risk biomarkers. Type I IFNs may play a critical role in lupus CVD pathogenesis, and it is recommended that vascular outcomes be included in ongoing trials testing the efficacy of anti-IFN biologics.

Nocturnal Hypertension and Attenuated Nocturnal Blood Pressure Dipping is Common in Pediatric Lupus

“…This is related to both traditional and non-traditional risk factors in adult patients ( Knight & Kaplan, 2013). In a study of 94 adults with SLE, correlations were noted between intima-medial thickness and clinical disease activity scores ( Oryoji et al , 2013).…”

“…Cardiovascular disease is a leading cause of mortality in adults with SLE and though there are many non-traditional risk factors including altered renal function, impaired endothelial function, chronic inflammation, and an activated renin-angiotensin system (RAS) ( Gustafsson et al , 2012; Kiani et al , 2008; Knight & Kaplan, 2013; Pieretti et al , 2007), HTN is still an important risk factor ( Contreras et al , 2005; Ginzler et al , 1993; Petrin et al , 1993; Yang et al , 1994). Therefore the use of standardized definitions to define HTN in SLE patients is crucial in better understanding cardiovascular risk and preventing adverse outcomes.…”

Specific features of hypertension in patients with systemic lupus erythematosus

“…Савина Жанна Евеньевна -к.м.н., врач функциональной диагно-стики; e-mail: jeanneSav@yandex.ru Сердечно-сосудистые осложнения (ССО), обуслов-ленные развитием артериальной гипертонии (АГ) и ран-ним атеросклеротическим поражением сосудов, являются одними из основных причин летальности при ревматиче-ских заболеваниях [1][2][3][4].…”

The Plot Thickens Further for Type I Interferons in Atherosclerotic Disease

“…5 Mouse models for SLE were shown to have increased atherosclerosis, 6 and type I IFNs cause endothelial dysfunction in relation to atherosclerotic disease. 7 Moreover, it was recently shown in mice that type I IFNs promote the expression of chemotactic receptors and ligands (CCR5 [CC chemokine receptor] and CCL5 [CC chemokine ligand]) and thereby promote monocyte vessel wall interactions, recruitment of cells to atherosclerotic lesions, and hence promote atherogenesis. In human atherosclerotic lesions, characteristics of plaque instability associated with an IFN signature profile.…”