Abstract
Patients with systemic lupus erythematosus (SLE) have a significantly increased risk of atherosclerotic coronary events. Traditional risk factors, such as hypertension and hypercholesterolemia, only partly account for the increased risk of coronary disease in SLE. Other important risk factors include disease and treatmentrelated factors. Novel markers of coronary risk in SLE are being investigated. Several methods have been used to detect subclinical atherosclerosis in patients with SLE. Among these, scintigraphic myocardial perfusion defects have been shown to be predictive of subsequent coronary events, independent of traditional Framingham risk factors. Although the aggressive treatment of reversible risk factors, such as lipids and blood pressure, is advocated by many, no published studies have yet demonstrated a clear reduction in risk of coronary events with this approach. Elucidation of risk factors and preventive strategies for accelerated atherosclerosis in SLE is the subject of ongoing research.
Similar content being viewed by others
References and Recommended Reading
Gladman DD, Urowitz MB: Morbidity in systemic lupus erythematosus. J Rheumatol Suppl 1987, 14(Suppl 13):223–226.
Rubin LA, Urowitz MB, Gladman DD: Mortality in systemic lupus erythematosus: the bimodal pattern revisited. Q J Med 1985, 55:87–98.
Urowitz MB, Bookman AA, Koehler BE, et al.: The bimodal mortality pattern of systemic lupus erythematosus. Am J Med 1976, 60:221–225.
Urowitz MB, Ibanez D, Gladman DD: Atherosclerotic vascular events in a single large lupus cohort: prevalence and risk factors. J Rheumatol 2007, 34:70–75.
Manzi S, Meilahn EN, Rairie 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.
Petri M, Perez-Gutthann S, Spence D, Hochberg MC: Risk factors for coronary artery disease in patients with systemic lupus erythematosus. Am J Med 1992, 93:513–519.
Bruce IN, Gladman DD, Urowitz MB: Premature atherosclerosis in systemic lupus erythematosus. Rheum Dis Clin North Am 2000, 26:257–278.
Adams RJ, Chimowitz MI, Alpert JS, et al.: Coronary risk evaluation in patients with transient ischemic attack and ischemic stroke: a scientific statement for healthcare professionals from the Stroke Council and the Council on Clinical Cardiology of the American Heart Association/American Stroke Association. Circulation 2003, 108:1278–1290.
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.
Roman MJ, Shanker BA, Davis A, et al.: Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. N Engl J Med 2003, 349:2399–2406.
Rahman P, Urowitz MB, Gladman DD, et al.: Contribution of traditional risk factors to coronary artery disease in patients with systemic lupus erythematosus. J Rheumatol 1999, 26:2363–2368.
Bruce IN, Urowitz MB, Gladman 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.
Esdaile JM, Abrahamowicz M, Grodzicky T, et al.: Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum 2001, 44:2331–2337.
Bruce IN, Urowitz MB, Gladman DD, Hallett DC: Natural history of hypercholesterolemia in systemic lupus erythematosus. J Rheumatol 1999, 26:2137–2143.
Rahman P, Aguero S, Gladman DD, et al.: Vascular events in hypertensive patients with systemic lupus erythematosus. Lupus 2000, 9:672–675.
Asia Pacific Cohort Studies Collaboration: Joint effects of systolic blood pressure and serum cholesterol on cardiovascular disease in the Asia Pacific region. Circulation 2005, 112:3384–3390.
Bostom AG, Rosenberg IH, Silbershatz H, et al.: Nonfasting plasma total homocysteine levels and stroke incidence in elderly persons: the Framingham Study. Ann Intern Med 1999, 131:352–355.
Stampfer MJ, Malinow MR, Willett WC, et al.: A prospective study of plasma homocyst(e)ine and risk of myocardial infarction in US physicians. JAMA 1992, 268:877–881.
Petri M, Roubenoff R, Dallal GE, et al.: Plasma homocysteine as a risk factor for atherothrombotic events in systemic lupus erythematosus. Lancet 1996, 348:1120–1124.
Roman MJ, Crow MK, Lockshin MD, et al.: Rate and determinants of progression of atherosclerosis in systemic lupus erythematosus. Arthritis Rheum 2007, 56:3412–3419.
Ross R: Atherosclerosis—an inflammatory disease. N Engl J Med 1999, 340:115–126.
Ridker PM: Clinical application of C-reactive protein for cardiovascular disease detection and prevention. Circulation 2003, 107:363–369.
Pearson TA, Mensah GA, Alexander RW, et al.: Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 2003, 107:499–511.
Lee SS, Singh S, Link K, Petri M: High-sensitivity C-reactive protein as an associate of clinical subsets and organ damage in systemic lupus erythematosus. Semin Arthritis Rheum 2008, 38:41–54.
Kiani AN, Magder L, Petri M: Coronary calcium in systemic lupus erythematosus is associated with traditional cardiovascular risk factors, but not with disease activity. J Rheumatol 2008, 35:1300–1306.
Selzer F, Sutton-Tyrrell K, Fitzgerald S, et al.: Vascular stiffness in women with systemic lupus erythematosus. Hypertension 2001, 37:1075–1082.
Doria A, Shoenfeld Y, Wu R, et al.: Risk factors for subclinical atherosclerosis in a prospective cohort of patients with systemic lupus erythematosus. Ann Rheum Dis 2003, 62:1071–1077.
Toloza SM, Uribe AG, McGwin G Jr, et al.: Systemic lupus erythematosus in a multiethnic US cohort (LUMINA). XXIII. Baseline predictors of vascular events. Arthritis Rheum 2004, 50:3947–3957.
Ibanez D, Gladman DD, Urowitz MB: Adjusted mean Systemic Lupus Erythematosus Disease Activity Index-2K is a predictor of outcome in SLE. J Rheumatol 2005, 32:824–827.
Karp I, Abrahamowicz M, Fortin PR, et al.: Recent corticosteroid use and recent disease activity: independent determinants of coronary heart disease risk factors in systemic lupus erythematosus? Arthritis Rheum 2008, 59:169–175.
Petri M, Lakatta C, Magder L, Goldman D: Effect of prednisone and hydroxychloroquine on coronary artery disease risk factors in systemic lupus erythematosus: a longitudinal data analysis. Am J Med 1994, 96:254–259.
Sachet JC, Borba EF, Bonfa E, et al.: Chloroquine increases low-density lipoprotein removal from plasma in systemic lupus patients. Lupus 2007, 16:273–278.
Wallace DJ, Metzger AL, Stecher VJ, et al.: Cholesterollowering effect of hydroxychloroquine in patients with rheumatic disease: reversal of deleterious effects of steroids on lipids. Am J Med 1990, 89:322–326.
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.
Johansson E, Forsberg K, Johnsson H: Clinical and experimental evaluation of the thromboprophylactic effect of hydroxychloroquine sulfate after total hip replacement. Haemostasis 1981, 10:89–96.
Petri M, Yoo S-S: Predictors of glucose intolerance in systemic lupus erythematosus. Arthritis Rheum 1994, 37:S323.
Sherer Y, Shoenfeld Y: Antiphospholipid antibodies: are they pro-atherogenic or an epiphenomenon of atherosclerosis? Immunobiology 2003, 207:13–16.
Ahmad Y, Shelmerdine J, Bodill H, et al.: Subclinical atherosclerosis in systemic lupus erythematosus (SLE): the relative contribution of classic risk factors and the lupus phenotype. Rheumatology (Oxford) 2007, 46:983–988.
Nikpour M, Urowitz MB, Gladman DD: Premature atherosclerosis in systemic lupus erythematosus. Rheum Dis Clin North Am 2005, 31:329–354, vii–viii.
O’Leary DH, Polak JF, Kronmal RA, et al.: Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999, 340:14–22.
van der Meer IM, Bots ML, Hofman A, et al.: Predictive value of noninvasive measures of atherosclerosis for incident myocardial infarction: the Rotterdam Study. Circulation 2004, 109:1089–1094.
Nallamothu BK, Saint S, Bielak LF, et al.: Electron-beam computed tomography in the diagnosis of coronary artery disease: a meta-analysis. Arch Intern Med 2001, 161:833–838.
Asanuma Y, Oeser A, Shintani AK, et al.: Premature coronary-artery atherosclerosis in systemic lupus erythematosus. N Engl J Med 2003, 349:2407–2415.
Hosenpud JD, Montanaro A, Hart MV, et al.: Myocardial perfusion abnormalities in asymptomatic patients with systemic lupus erythematosus. Am J Med 1984, 77:286–292.
Nikpour M, Gladman DD, Ibanez D, et al.: Myocardial perfusion imaging in assessing risk of coronary events in patients with systemic lupus erythematosus. J Rheumatol 2009, 36:288–294.
Bruce IN: ’Not only…but also’: factors that contribute to accelerated atherosclerosis and premature coronary heart disease in systemic lupus erythematosus. Rheumatology (Oxford) 2005, 44:1492–1502.
Wajed J, Ahmad Y, Durrington PN, Bruce IN: Prevention of cardiovascular disease in systemic lupus erythematosus—proposed guidelines for risk factor management. Rheumatology (Oxford) 2004, 43:7–12.
Chobanian AV, Bakris GL, Black HR, et al.: The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA 2003, 289:2560–2572.
Grundy SM, Cleeman JI, Merz CN, et al.: Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004, 110:227–239.
Ridker PM, Danielson E, Fonseca FA, et al.: Rosuvastatin to prevent vascular events in men and women with elevated C-reactive protein. N Engl J Med 2008, 359:2195–2207.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nikpour, M., Urowitz, M.B. & Gladman, D.D. Epidemiology of atherosclerosis in systemic lupus erythematosus. Curr Rheumatol Rep 11, 248–254 (2009). https://doi.org/10.1007/s11926-009-0035-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11926-009-0035-z