TY - JOUR
TI - Cardiovascular disease in systemic lupus erythematosus: Recent data on epidemiology, risk factors and prevention
AU - Kostopoulou, M.
AU - Nikolopoulos, D.
AU - Parodis, I.
AU - Bertsias, G.
JO - Current Vascular Pharmacology
PY - 2020
VL - 18
TODO - 6
SP - 549-565
PB - Bentham Science Publishers
SN - 1570-1611
TODO - 10.2174/1570161118666191227101636
TODO - acetylsalicylic acid;  antihypertensive agent;  antimalarial agent;  apolipoprotein A1;  autoantibody;  azathioprine;  belimumab;  biological marker;  corticosteroid;  cyclic citrullinated peptide antibody;  cyclophosphamide;  cyclosporine;  cytokine;  dexamethasone;  disease modifying antirheumatic drug;  endothelial nitric oxide synthase;  endothelin 1;  fluindostatin;  glucocorticoid;  high density lipoprotein cholesterol;  homocysteine;  hydroxychloroquine;  hydroxymethylglutaryl coenzyme A reductase inhibitor;  immunoglobulin enhancer binding protein;  inflammasome;  interferon;  interleukin 17;  leptin;  lipoprotein;  low density lipoprotein cholesterol;  methotrexate;  mycophenolate mofetil;  phospholipid antibody;  prednisone;  reactive oxygen metabolite;  rosuvastatin;  statine;  toll like receptor 4;  triacylglycerol;  tumor necrosis factor;  vasculotropin;  immunologic factor, arterial stiffness;  arterial wall thickness;  atherosclerosis;  brain hemorrhage;  cardiovascular disease;  cardiovascular mortality;  cardiovascular risk;  carotid atherosclerosis;  cerebrovascular disease;  computed tomographic angiography;  computer assisted tomography;  coronary artery atherosclerosis;  disease activity;  disease association;  dyslipidemia;  echocardiography;  endothelial dysfunction;  heart failure;  heart infarction;  heart muscle perfusion;  human;  hyperlipidemia;  hypertension;  hypertriglyceridemia;  intermittent claudication;  ischemic heart disease;  lifestyle modification;  lupus erythematosus nephritis;  metabolic syndrome X;  neutrophil count;  nonhuman;  nuclear magnetic resonance imaging;  oxidative stress;  pathophysiology;  peripheral occlusive artery disease;  prevalence;  Review;  rheumatoid arthritis;  risk assessment;  risk factor;  smoking cessation;  systemic lupus erythematosus;  animal;  cardiovascular disease;  comorbidity;  immunology;  lifestyle;  prognosis;  protection;  systemic lupus erythematosus, Animals;  Cardiovascular Diseases;  Comorbidity;  Heart Disease Risk Factors;  Humans;  Immunologic Factors;  Life Style;  Lupus Erythematosus, Systemic;  Prognosis;  Protective Factors;  Risk Assessment
TODO - Systemic Lupus Erythematosus (SLE) is associated with increased risk for accelerated atherosclerosis and cardiovascular (CV) events including coronary heart disease, cerebrovascular and peripheral artery disease. CV events occur both early and late during the disease course, with younger patients being at much higher risk than age-matched counterparts. The risk cannot be fully accounted for by the increased prevalence of traditional atherosclerotic factors and may be due to pathophysiologic intermediates such as type I interferons and other inflammatory cytokines, oxidative stress, activated granulocytes and production of extracellular chromatin traps, antiphospholipid and other autoantibodies causing dysfunction of lipoproteins, altogether resulting in endothelial injury and pro-atherogenic dyslipidaemia. These mechanisms may be further aggravated by chronic intake of prednisone (even at doses <7.5 mg/day), whereas immunomodulatory drugs, especially hydroxychloroquine, may exert anti-atherogenic properties. To date, there is a paucity of randomized studies regarding the effectiveness of preventative strategies and pharmacological interventions specifically in patients with SLE. Neverthe-less, both the European League Against Rheumatism recommendations and extrapolated evidence from the general population emphasize that SLE patients should undergo regular monitoring for atheroscle-rotic risk factors and calculation of the 10-year CV risk. Risk stratification should include disease-related factors and accordingly, general (lifestyle modifications/smoking cessation, antihypertensive and statin treatment, low-dose aspirin in selected cases) and SLE-specific (control of disease activity, mini-mization of glucocorticoids, use of hydroxychloroquine) preventive measures be applied as appropriate. Further studies will be required regarding the use of non-invasive tools and biomarkers for CV assessment and of risk-lowering strategies tailored to SLE. © 2020 Bentham Science Publishers.
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