Case 1: A 40-year-old woman with myocardial infarction A 40-year-old female was diagnosed with systemic lupus erythematosus (SLE) at the age of 30 based on malar rash, arthritis, positive antinuclear antibodies, anti-double-stranded DNA antibodies, hypocomplementaemia, and biopsy-proven Class IV lupus nephritis. She was treated with glucocorticoids (GC), hydroxychloroquine (HCQ), and intravenous pulses of cyclophosphamide followed by mycophenolate mofetil (MMF) achieving complete remission 6 months later. Four years later, she suffered from a second SLE flare in the form of Class IV lupus nephritis as well as arthritis, receiving induction treatment with GC and MMF and achieving complete renal response 8 months later. She remained in lupus low disease activity for the next 5 years with prednisone 2.5 mg/day, HCQ 300 mg/day, and MMF 500 mg/12h. She was a current smoker, and her previous history included arterial hypertension and dyslipidaemia treated with enalapril 10 mg/day and atorvastatin 20 mg/day.
At the current admission, she presented at Emergency Department with thoracic pain and shortness of breath. She was diagnosed with myocardial infarction. Coronary angiography showed an atherosclerotic plaque in anterior descending coronary artery that required percutaneous coronary intervention and stenting. The patient was discharged without acute complications under treatment with dual platelet anti-aggregation.
What could we have done to avoid this outcome?
Discuss the general management of cardiovascular risk factors in patients with SLE
Discuss the usefulness of different scoring tools to assess the atherosclerotic cardiovascular disease in SLE patients and the potential utility of imaging
Discuss the objectives of treatment (primary prevention) of the different cardiovascular risk factors (hypertension, dyslipidaemia, tobacco) in SLE patients and the indications of aspirin in primary prevention
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