Jitaru Alexandra MD, PhD
University of Medicine and Pharmacy “Grigore T. Popa” Iasi
Cardiovascular manifestations in systemic lupus erythematosus
Authors: Alexandra Jitaru, Codrina Ancuta, Maria Magdalena Leon-Constantin, Alexandra Mastaleru, Florin Mitu
Systemic lupus erythematosus (SLE), a multifactorial autoimmune disease with many visceral implications, has as a complex pathobiology governed by a cascade of inflammatory events involving different cytokines and growth factors, leading to accelerated cellular turn-over, cell proliferation and angiogenesis, as well as loss of self-tolerance.
Various research papers already showed a high prevalence of traditional cardiovascular risk factors (e.g. diabetes, hypertension, smoking, abdominal obesity, hypercholesterolemia) in patients with SLE; however, these factors cannot entirely explain the increased incidence of ischemic events associated with SLE. Furthermore, a direct involvement of immune-mediated inflammatory phenomena strictly related to the disease are widely recognized to increase the cardiovascular risk in such patients.
The cardiovascular comorbidities associated with SLE include the subclinical atherosclerosis, quantified by measuring the carotid intima-media thickness and myocardial perfusion abnormalities, and the clinical manifestations represented by coronary disease, myocarditis, pericarditis as well as valvulopathy.
Current guidelines recommend to multiply by 1.5 the scores defining the cardiovascular risk in patients with autoimmune diseases other than rheumatoid arthritis (including SLE), depending on the severity and / or activity of the disease. From statistical point of view, recent studies highlighted the fact that cardiovascular damage is the most common cause of death in patients with a disease duration of more than 5 years, this occurring much more frequently and earlier in SLE patients compared to the general population.
SLE management classically aims to the proper control of the immune-mediated inflammatory process and the regaining of self-tolerance, with the implicit slow-down of the atherosclerotic process.
Hydroxychloroquine is commonly used in the treatment of SLE and has demonstrated its cardiovascular protective role in numerous studies, particularly by its action in the subclinical stages of cardiovascular disease.