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Cardiovascular risk assessment in patients with systemic lupus erythematosus: practical aspects
 
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Online publication date: 2011-12-28
 
 
Reumatologia 2011;49(6):419-425
 
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ABSTRACT
Cardiovascular disease is one of the leading causes of deaths in patients with systemic lupus erythematosus (SLE). It occurs more often and at a younger age than in the general population (Table I). The causes of this phenomena have not yet been explained. Accelerated atherosclerosis is related to elevated total cholesterol, coexisting autoimmunization and chronic glucocorticoids treatment. In practice, patients with SLE are treated as a group of high risk of cardiovascular complications. In the paper authors present classic and SLE – specific risk factors leading to atherosclerotic vascular events (Table II). Attention is focused on probable benefits of antimalarial treatment. The significance of additional imagining investigations, including carotid duplex for assessment of intimae media thickness/plaque, in diagnosis of atherosclerosis is reviewed. At the moment no clear recommendations have been defined related to primary and secondary preventive methods for SLE patients. Finally, a strategy of management is proposed (Table III).
REFERENCES (60)
1.
Salmon JE, Roman MJ. Accelerated atherosclerosis in SLE: implications for patients management. Curr Opin Rheumatol 2001; 13: 341-344.  .
 
2.
Manzi S, Meilhan EN, Raire JE, et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham Study. Am J Epidemiol 1997; 145: 408-415.  .
 
3.
Bessant R, Duncan R, Ambler G, et al. Prevalence of conventional and lupus-specific risk factors for cardiovascular disease in patients with systemic lupus erythematosus: a case-control study. Arthritis Rheum 2006; 55: 892-899.  .
 
4.
Urowitz MB, Bookman AM, Kocher BE, et al. The bimodal mortality in SLE. Am J Med 1976; 60: 221-225.  .
 
5.
Ward M, Puyn E, Studenski S. Causes of death in systemic lupus erythematosus: long term follow up of an Inception Cohort. Arthritis Rheum 1995; 38: 1492-1499.  .
 
6.
Bessant R, Hingorani A, Patel L, et al. Risk of coronary heart disease and stroke in patients with systemic lupus erythematosus. Rheumatology (Oxford) 2004; 43: 924-929.  .
 
7.
Futrell N, Millikan C. Frequency, etiology, and prevention of stroke in patients with systemic lupus erythematosus. Stroke 1989; 20: 583-591.  .
 
8.
Bruce IN, Urowitz MB, Gladmann DD, et al. Risk factors for coronary heart disease in women with systemic lupus erythematosus: the Toronto Risk Factor Study. Arthritis Rheum 2003; 48: 3159-3167.  .
 
9.
Svengusson E, Jenssen-Urstad K, Heimbuerger M, et al. Risk factors for cardiovascular disease in systemic lupus erythematosus. Circulation 2001; 104: 1887-1893. .
 
10.
Von Feldt JM, Scalzi LV, Cucchiara AJ, et al. Homocysteine levels and disease duration independently correlate with coronary artery calcification in patients with systemic lupus erythematosus. Arthritis Rheum 2006; 54: 2220-2227. .
 
11.
Petri M, Perez-Gutthann S, Spence D, et al. Risk factors for coronary artery disease in patients with systemic lupus erythematosus. Am J Med 1992; 93: 513-519. .
 
12.
orba EF, Santos RD, Bonfa E, et al. Lipoprotein(a) levels in systemic lupus erythematosus. J Rheumatol 1994; 21: 220-223. .
 
13.
Sarkissian T, Beyenne J, Feldman B, et al. The complex nature of the interaction between disease activity and therapy on the lipid profile in patients with pediatric systemic lupus erythematosus. Arthritis Rheum 2006; 54: 1283-1290. .
 
14.
Borba EF, Bonfa E. Dyslipoproteinemias in systemic lupus erythematosus: influence of disease, activity, and anticardiolipin antibodies. Lupus 1997; 6: 533-539. .
 
15.
Urquizu-Padilla M, Balada E, Chacon P, et al. Changes in lipid profile between flare and remission of patients with systemic lupus erythematosus: a prospective study. J Rheumatol 2009; 36: 1639-1645. .
 
16.
Russell R. Atherosclerosis – an inflammatory disease. N Engl J Med 1999; 340: 115-126. .
 
17.
Nuttall SL, Heaton S, Piper MK, et al. Cardiovascular risk in systemic lupus erythematosus – evidence of increased oxidative stress and dyslipidaemia. Rheumatology (Oxford) 2003; 42: 758-762. .
 
18.
López-Pedrera CH, Aguirre MÁ, Barbaroja N, et al. Accelerated atherosclerosis in systemic lupus erythematosus: role of proinflammatory cytokines and therapeutic approaches. J Biomed Biotechnol 2010. Published online 2010 September 26. .
 
19.
Urowitz MB, Gladmann DD. Accelerated atheroma in lupus-background. Lupus 2000; 9: 161-165. .
 
20.
Asanuma Y, Chung CP, Oeser A, et al. Increased concentration of proatherogenic inflammatory cytokines in systemic lupus erythematosus: relationship to cardiovascular risk factors. J Rheumatol 2006; 33: 539-545. .
 
21.
Svenungsson E, Fei GZ, Jensen-Urstad K, et al. TNF-alpha: a link between hypertriglyceridaemia and inflammation in SLE patients with cardiovascular disease. Lupus 2003; 12: 454-461. .
 
22.
Elliot JR, Manzi S. Cardiovascular risk assessment and treatment in systemic lupus erythematosus. Best Pract Res Clin Rheumatol 2009; 23: 481-494. .
 
23.
Bertoli AM, Vila LM, Alarcon GS. Factors associated with arterial vascular events in PROFILE: a Multiethnic Lupus Cohort. Lupus 2009; 18: 958-965. .
 
24.
Rand JH, Wu XX, Quinn AS, et al. Human monoclonal antiphospholipid antibodies disrupt the annexin A5 anticoagulant crystal shield on phospholipid bilayers: evidence from atomic force microscopy and functional assay. Am J Pathol 2003; 163: 1193-1200. .
 
25.
Vaarala O. Antibodies to oxidized LDL. Lupus 2000; 9: 202-205. .
 
26.
Skamra C, Ramsey-Goldman R. Management of cardiovascular complications in .
 
27.
emic lupus erythematosus. Int J Clin Rheumtol 2010; 5: 75-100. .
 
28.
Falaschi F, Ravelli A, Martignoni A, et al. Nephrotic-range proteinuria, the major risk factor for early atherosclerosis in juvenile-onset systemic lupus erythematosus. Arthritis Rheum 2000; 43: 1405-1409. .
 
29.
Sule S, Fivush B, Furth S. Increased risk of death in pediatric and adult patients with ESRD secondary to lupus. Pediatr Nephrol 2011; 26: 93-98. .
 
30.
Wells DK, Ward MM. Nephritis and the risk of acute myocardial infarction in patients with systemic lupus erythematosus. Clin Exp Rheumatol 2010; 28: 223-229. .
 
31.
Bulkley BH, Roberts WC. Coronary arterial disease in systemic lupus erythematosus and the changes induced in it by corticosteroid therapy. A study of 36 necropsy patients. Am J Med 1975; 58: 243-264. .
 
32.
MacGregor AJ, Dhilon VB, Binder A, et al. Fasting lipids and anticardiolipin antibodies as risk factors for vascular disease in systemic lupus erythematosus. Ann Rheum Dis 1992; 51: 152-155. .
 
33.
Ettinger WH, Goldberg AP, Applebaum-Bowden D, et al. Dyslipoproteinemia in systemic lupus erythematosus. Effect of corticosteroids. Am J Med 1987; 83: 503-508. .
 
34.
Fischer K. Czynniki ryzyka pogrubienia kompleksu błony wewnętrznej i środkowej oraz rozwoju blaszki miażdżycowej w tętnicach szyjnych u chorych na toczeń rumieniowaty układowy. Roczniki PAM 2008; 54: 222-232. .
 
35.
Roman MJ, Shaker BA, Davis A, et al. Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. N Engl J Med 2003; 349: 2399-2406. .
 
36.
Fessler BJ, Alarcón GS, McGwin G Jr, et al.; LUMINA Study Group. Systemic lupus erythematosus in three ethnic groups: XVI. Association of hydroxychloroquine use with reduced risk of damage accrual. Arthritis Rheum 2005; 52: 1473-1480. .
 
37.
Hodis HN, Quismorio FP Jr, Wickham E, et al. The lipid, lipoprotein, and apolipoprotein effects of hydroxychloroquine in patients with systemic lupus erythematosus. J Rheumatol 1993; 20: 661-665. .
 
38.
Rahman P, Gladman DD, Urowitz MB, et al. The cholesterol lowering effect of antimalarial drugs is enhanced in patients with lupus taking corticosteroid drugs. J Rheumatol 1999; 26: 325-330. .
 
39.
Tam LS, Gladman DD, Hallett DC, et al. Effect of antimalarial agents on the fasting lipid profile in systemic lupus erythematosus. J Rheumatol 2000; 27: 2142-2145. .
 
40.
Penn SK, Kao AH, Schott L, et al. Hydroxychloroquine and glycemia in women with rheumatoid arthritis and systemic lupus erythematosus. J Rheumatol 2010; 37: 1136-1142. .
 
41.
Tektonidou MG, Laskari K, Panagiotakos DB, et al. Risk factors for thrombosis and primary thrombosis prevention in patients with systemic lupus erythematosus with or without antiphospholipid antibodies. Arthritis Rheum 2009; 61: 29-36. .
 
42.
European guidelines on cardiovascular disease prevention in clinical executive summary. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice. Eur Heart J 2007; 28: 2375-2414. .
 
43.
Peters MJ, Symmons DP, McCarey D, et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 2010; 69: 325-331. .
 
44.
Wajed W, Ahmad Y, Durington N, et al. Prevention of cardiovascular disease in systemic lupus erythematosus – proposed guidelines for risk factor management. Rheumatology (Oxford) 2004; 43: 7-12. .
 
45.
Esdaile JM, Abrahamowicz M, Grodzicky T, et al. Traditional Framingham risk factors fail fully to account for accelerated atherosclerosis in systemic lupus erythematosus. Arthiritis Rheum 2001; 44: 2331-2337. .
 
46.
Chung CP, Oeser A, Avalos I, et al. Cardiovascular risk scores and the presence of subclinical coronary artery atherosclerosis in women with systemic lupus erythematosus. Lupus 2006; 15: 562-569. .
 
47.
Lloyd-Jones DM, Newby KM, Pina LI, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women – 2011 update. J Am Coll Cardiol 2011; 57: 1404-1423. .
 
48.
Hallegua DS, Wallace DJ. How accelerated atherosclerosis in SLE has changed our management of the disorder. Lupus 2000; 9: 228-231. .
 
49.
Chambless LE, Heiss G, Folsom AR, et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: The Atherosclerosis Risk in Community (ARIC) Study, 1987-1993. Am J Epidemiol 1997; 146: 483-494. .
 
50.
Salonen JT, Salonen R. Ultrasonographically assessed carotid morphology and the risk of coronary heart disease. Arterioscler Thromb 1991; 11: 1245-1249. .
 
51.
Manzi S, Selzer F, Sutton-Tyrrell K, et al. Prevalence and risk factors of carotid plaque in women with systemic lupus erythematosus. Arthritis Rheum 1999; 42: 51-60. .
 
52.
Sella EM, Sato EI, Leite WA, et al. Myocardial perfusion scintigraphy and coronary disease risk factors in systemic lupus erythematosus. Ann Rheum Dis 2003; 62: 1066-1070. .
 
53.
Abeles AM, Pilinger MH. Statins as antinflammatory and immunomodulatory agents. Arthritis Rheum 2006; 54: 393-407. .
 
54.
Kwak B, Mulhaupt F, Myit S, et al. Statins as a newly recognized type of immunomodulator. Nat Med 2000; 6: 1399-1402. .
 
55.
Ferreira GA, Navarro TP, Telles RW, et al. Atorvastatin therapy improves endothelial-dependent vasodilatation in patients with systemic lupus erythematosus: an 8 weeks controlled trial. Rheumatology 2007; 46: 1560-1565. .
 
56.
Kotyla PJ, Sliwinska-Kotyla B, Kucharz EJ. TNF- as a potential target in the treatment of systemic lupus erythematosus: a role for the HMG-CoA reductase inhibitor simvastatin. J Rheumatol 2006; 33: 2361-2363. .
 
57.
Petri MA, Kiani AN, Post W, et al. Lupus Atherosclerosis Prevention Study (LAPS). Ann Rheum Dis 2011; 70: 760-765. .
 
58.
McCarey DW, McInnes IB, Madhok R, et al. Trial of Atorvastatin in Rheumatoid Arthritis (TARA): double-blind, randomized placebo-controlled trial. Lancet 2004; 363: 2015-2021. .
 
59.
Bruce IN, Gladman DD, Urowitz MB. Detection and modification of risk factors for coronary artery disease in patients with systemic lupus erythematosus: a quality improvement study. Clin Exp Rheumatol 1998; 16: 435-440. .
 
60.
Urowitz MB, Gladman D, Iban~ez D, et al. Atherosclerotic vascular events in a multinational inception cohort of systemic lupus erythematosus. Arthritis Care Res (Hoboken) 2010; 62: 881-887.
 
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