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

Abstract

Atherosclerosis is a chronic inflammatory disorder characterized by immune cell activation, inflammation driven plaque formation and subsequent destabilization. In other disorders of an inflammatory nature, the chronic inflammatory state per se has been linked to acceleration of the atherosclerotic process which is underlined by an increased incidence of cardiovascular disease (CVD) in disorders such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA) and antiphopholipid (Hughes) syndrome (APS). SLE is an autoimmune disease that may affect any organ. Premature coronary heart disease has emerged as a major cause of morbidity and mortality in SLE. In addition to mortality, cardiovascular morbidity is also markedly increased in these patients, compared with the general population. The increased cardiovascular risk can be explained only partially by an increased prevalence of classical risk factors for cardiovascular disease; it also appears to be related to inflammation. Inflammation is increasingly being considered central to the pathogenesis of atherosclerosis and an important risk factor for vascular disease. Recent epidemiologic and pathogenesis studies have suggested a great deal in common between the pathogenesis of prototypic autoimmune disease such as SLE and that of atherosclerosis.We will review traditional risk factors for CVD in SLE. We will also discuss the role of inflammation in atherosclerosis, as well as possible treatment strategies in these patients.

Women and Heart Disease: Understanding Risk Factors for Coronary Artery Disease

“…75 For patients with autoimmune disorders, disease modifying agents are preferred over corticosteroids, which have been linked to development of metabolic syndrome and premature atherosclerosis. 76 Biologics such as tumor necrosis factor antagonists and anti-CD40 agents are associated with lower rates of CVD.…”

Accelerated Atherosclerosis in Patients with Systemic Lupus Erythematosus and the Role of Selected Adipocytokines in This Process

“…in patients with SLE compared to the control [19,[22][23][24][25], while the CAD mortality rate ranges from 3.5 to 15.7% [26]. It should be noted that diagnostic imaging revealed subclinical atherosclerosis in 30-52% of SLE patients [24,25,27,28].…”

“…Although there is a lot of evidence that inlammation plays a central role in atherosclerosis, its pathogenesis is also associated with other risk factors often connected with SLE, that is arterial hypertension (especially renal hypertension), prolonged exposure to high doses of glucocorticoids (which, apart from having a beneicial anti-inlammatory action, also inluence blood pressure and glucose metabolism), lupus-associated antiphospholipid syndrome, diabetes mellitus, and hypercholesterolemia [23,25]. It should be noted that a regimen of ≤ 10 mg prednisone daily is considered safe in this respect [25]; however, the problem of metabolic disorders seen in SLE patients and its relation to glucocorticoid doses has not been satisfactorily elucidated.…”

“…Researchers are often confronted with inconsistent results [23,42]; hence, it has been suggested SLE might be considered an independent risk factor for atherosclerosis including CAD [24,[43][44][45] and CVD [23].…”

Human immunosuppressive protein, galectin-1 emerges as a novel regulatory factor in autoimmune disorders

“…Clinical manifestations are very diverse, including the most frequent symptoms of polyarthritis and various skin manifestations [100]. Furthermore, glomerulonephritis, central and peripheral nervous system pathology, inflammation in the serous membranes, lung, muscles, eye and cardiovascular system as well as severe blood cytopenias also develop frequently [101][102][103][104]. Very complex immune dysregulation has been explored, including T-and B-cell functional alterations that eventually lead to the loss of peripheral tolerance [105,106].…”