ImmunoTargets and Therapy (Dec 2023)
Managing Cardiovascular Risk in Systemic Lupus Erythematosus: Considerations for the Clinician
Abstract
Teresa Semalulu,1 Achieng Tago,2 Kevin Zhao,3 Konstantinos Tselios1 1Division of Rheumatology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; 2Division of Cardiology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; 3Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, CanadaCorrespondence: Konstantinos Tselios, Division of Rheumatology, Department of Medicine, McMaster University, 1280 Main St W, HSC 3H1B, Hamilton, Ontario, L8S 4K1, Canada, Tel +1 905 521 2100 Ext. 76714, Fax +1 905 521 4971, Email [email protected]: A significant improvement in the survival of patients with systemic lupus erythematosus (SLE) over recent decades is largely attributed to the impact of disease-modifying therapies on end-organ damage. Thus, cardiovascular disease now represents the leading cause of mortality in SLE. Various disease-specific mechanisms are responsible for advanced atherosclerosis, as they lead to premature endothelial dysfunction, arterial stiffness, arterial wall thickening, and plaque formation. Consequently, in the assessment of cardiovascular risk in SLE, we must not only consider traditional risk factors (ie, age, gender, dyslipidemia) but also the additional role of non-traditional risk factors such as persistent disease activity and prolonged corticosteroid use. Cardiovascular risk assessment incorporates general cardiovascular screening, as existing risk prediction scores underestimate cardiovascular risk in this patient population. There is also an expanding role of imaging modalities in screening. Risk reduction strategies integrate unique considerations for the use of low-dose aspirin and more stringent hypertension targets. Hydroxychloroquine is the only disease-modifying therapy with known cardiovascular benefit in SLE, though this is a promising area of study.Keywords: cardiovascular disease, atherosclerosis, endothelial dysfunction, coronary artery disease, risk stratification, prevention
