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Atherosclerosis in Systemic Lupus Erythematosus

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Abstract

Purpose of the Review

Systemic lupus erythematosus (SLE) patients are at increased risk of cardiovascular disease (CVD) compared to the general population, despite most patients being young females, who are not classically considered to be at high risk for cardiovascular disease using traditional risk assessment tools. The purpose of this review is to discuss the pathophysiology of atherosclerosis in SLE and raise awareness of the relationship between SLE and CVD.

Recent Findings

The increased risk of CVD in SLE patients is multifactorial, due to proatherogenic lipid profiles, immune dysregulation and inflammation, side effects of lupus treatment, and microvascular dysfunction. Conventional CV risk models often underperform in the identification of SLE patients at high risk of atherosclerosis. The use of non-invasive imaging serves as a strategy to identify patients with evidence of subclinical CVD and in the evaluation of symptomatic patients. Identification of subclinical atherosclerosis allows for aggressive management of CV risk factors.

Summary

SLE patients experience an increased risk of atherosclerotic CVD, which is not solely explained by traditional CV risk factors. It is imperative that clinicians are aware of this association to implement prompt detection and treatment of atherosclerotic CVD in SLE patients.

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Authors and Affiliations

  1. Division of Cardiology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA

    Rachel Tobin

  2. Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA

    Nidhi Patel

  3. Cone Health Medical Group, Greensboro, NC, USA

    Kardie Tobb

  4. Division of Cardiology, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Brittany Weber

  5. Division of Cardiology, Department of Medicine, Center for Heart Disease Prevention, Emory University School of Medicine, Atlanta, GA, USA

    Puja K. Mehta & Ijeoma Isiadinso

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  1. Rachel Tobin
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Correspondence to Rachel Tobin.

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Conflict of Interest

Brittany Weber reports personal fees for the Scientific Advisory Board from Novo Nordisk, Kiniksa, and Novo Nordisk. Ijeoma Isiadinso serves as the site principal investigator on the Novartis-sponsored HORIZON study, but does not personally receive any funds, and their institution receives payment for services provided by study coordinators from Novartis Pharmaceuticals. In addition, Dr. Isiadinso receives consulting fees from Novartis Pharmaceuticals. The other authors declare that they have no conflict of interest.

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Tobin, R., Patel, N., Tobb, K. et al. Atherosclerosis in Systemic Lupus Erythematosus. Curr Atheroscler Rep 25, 819–827 (2023). https://doi.org/10.1007/s11883-023-01149-4

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