LAUSR

AIMS To provide an update on the epidemiology, risk factors and prevention strategies for cardiovascular diseases in patients with Systemic Lupus Erythematosus (SLE). BACKGROUND SLE is linked to increased risk for accelerated atherosclerosis and cardiovascular events. OBJECTIVE Systematic review of published literature pertaining to frequency, risk factors, and prevention strategies in SLE patients. METHOD Review of articles published in PubMed (period 2010-2019). RESULT SLE patients are at increased CVD risk that cannot be fully accounted by the increased prevalence of traditional atherosclerotic factors and may be due to pathophysiologic intermediates such as type I interferon and other inflammatory cytokines, oxidative stress, activated granulocytes and production of extracellular chromatin traps, antiphospholipid and other autoantibodies causing dysfunction of lipoproteins, altogether resulting in endothelial injury and pro-atherogenic dyslipidemia. These mechanisms may be further aggravated by chronic intake of prednisone (even at doses less than 7.5 mg per day), whereas immunomodulatory drugs, especially hydroxychloroquine, may exert anti-atherogenic properties. To date, there is paucity of randomized studies regarding the effectiveness of preventative strategies and pharmacological interventions specifically in patients with SLE. Nevertheless, both the European League Against Rheumatism recommendations and extrapolated evidence from the general population emphasize that SLE patients should undergo regular monitoring for atherosclerotic risk factors and calculation of the 10-year cardiovascular risk. Risk stratification may be amended according to disease-related factors and accordingly, general (lifestyle modifications/smoking cessation, antihypertensive and statin treatment, low-dose aspirin in selected cases) and SLE-specific (control of disease activity, minimization of glucocorticoids, use of hydroxychloroquine) preventative measures be applied. CONCLUSION SLE patients warrant regular assessment of their cardiovascular risk with prompt initiation of general and disease-specific risk-lowering strategies. Other: Further studies will be required regarding the use of non-invasive tools and biomarkers for cardiovascular assessment and of risk-lowering strategies tailored to SLE patients.