Accelerated atherosclerosis in systemic lupus erythematosus: perspectives towards decreasing cardiovascular morbidity and mortality

Autoimmune diseases are associated with higher rates of cardiovascular morbidity and mortality, primarily secondary to accelerated atherosclerosis. This phenomenon can be attributed to traditional risk factors for atherosclerosis and the use of specific drugs, such as corticosteroids, but also might be the result of other inflammatory mechanisms that are aggravated in autoimmune diseases. 1 Mounting evidence from a growing body of epidemiological studies demonstrate that patients with systemic lupus erythematosus (SLE) are at increased risk for the development of premature cardiovascular disease (CVD). Atherosclerosis is the most common cardiac abnormality. Although lesions of the valves, myocardium and pericarditis may all occur, cardiac manifestations are often mild and asymptomatic, and they can frequently be recognized by echocardiography and other noninvasive tests. 2 Coronary artery disease (CAD) is described in SLE patients with a prevalence ranging from 6 to 10%, and the risk of developing this manifestation is four to eight times higher than normal. 3 Moreover, acute myocardial infarction is the cause of death in 3–25% of SLE patients in different reports. 4