Elucidating the Intriguing Association Between Systemic Lupus Erythematosus and Cardiovascular Disease.

Mushrin Malik,Nabeel A Siddiqui,Rajvi Gor,Kazi I Ahmed,Dhairya Gor

doi:10.7759/cureus.15538

Abstract

Systemic lupus erythematosus (SLE) patients have demonstrated a higher risk of developing cardiovascular disease (CVD), resulting in it being one of the leading causes of death in SLE patients. SLE itself acts as a sole risk factor influencing the prevalence and progression of CVD. However, conventional risk factors, such as age, hypertension, smoking, and obesity, play a crucial role as well. Therefore, this systematic review attempts to unravel the association of CVD in SLE patients while evaluating the role of conventional risk factors.Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed to search the PubMed database starting from March 2021 systematically. Original studies that evaluated the prevalence and progression of CVD in SLE patients were extracted by two reviewers independently. Quality in Prognostic Studies (QUIPS) tool was used to assess the risk of bias. Most studies have a moderate to low risk of bias. Among 3,653 studies identified by our search, 10 studies were included in the review. Strong epidemiologic evidence of SLE patients having an increased relative risk of CVD compared to controls was found. Traditional CVD risk factors, such as age, hypertension, obesity, and smoking, influence the prevalence of CVD among SLE patients. Several SLE-specific factors such disease activity, duration, and certain medications also acted as influencing factors. However, the relative risk of CVD was still higher in SLE patients after adjustment of certain risk factors. One study found that the odds of having a Coronary Artery Calcification (CAC) score greater than zero in women with SLE aged less than or equal to 45 years was 12.6 times higher than women in the Coronary Artery Risk Development in Young Adults (CARDIA) cohort (95% CI 5.2 to 30.7) (participants of CARDIA cohort acted as control). This finding was made after age, hypertension, total cholesterol levels, and aspirin use were adjusted, and the study was restricted to women.Although conventional risk factors increase CVD prevalence, SLE itself also dramatically increases the prevalence of CVD. Therefore, we recommend that SLE should be treated as a "CVD risk equivalent." SLE patients should be managed more extensively with greater emphasis given to cardiac health for better clinical outcomes.

Highlights

BackgroundCardiovascular disease (CVD) is the leading cause of morbidity and mortality, both in developed and developing countries
Systemic lupus erythematosus (SLE) patients have demonstrated a higher risk of developing cardiovascular disease (CVD), resulting in it being one of the leading causes of death in SLE patients
Endothelial cell injury initiates atherosclerosis with deposition of oxidized low-density lipoprotein in the arterial wall resulting in the activation of monocytes, which get attracted to the subendothelial space and become activated macrophages

Summary

Introduction

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality, both in developed and developing countries. The underlying pathological change in CVD is atherosclerosis. Endothelial cell injury initiates atherosclerosis with deposition of oxidized low-density lipoprotein (oxLDL) in the arterial wall resulting in the activation of monocytes, which get attracted to the subendothelial space and become activated macrophages. Macrophages internalize oxLDL from the circulation and arterial smooth muscle cells, forming a lipid-rich cell called “foam cells.”. A variety of cytokines are produced by macrophages which accelerate smooth muscle cell and fibroblast migration. A plaque inside the vascular wall, known as an atheroma, is formed [1]

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