Background/Purpose: Premature coronary heart disease (CHD) represents a significant cause of morbidity and mortality in systemic lupus erythematosus (SLE). Several studies have been conducted to identify traditional and disease-related factors that have an impact on the atherosclerotic process, as well as methods to quantify the atherosclerotic burden in subclinical stages. Aim of this systematic review was to identify the minimum investigations to optimally monitor the risk of atherosclerotic CHD in SLE in routine practice.

Methods: An English-restricted systematic literature review was performed, using PRISMA guidelines, through Ovid Medline, Embase and the Cochrane Central databases from inception until the third week of May 2014. Specific search-terms included, among others, “systemic lupus erythematosus”, “atherosclerosis”, “coronary artery disease”, “myocardial ischemia”, “acute coronary syndrome”, “myocardial infarction”, “angina pectoris”. Two independent reviewers assessed all articles (5178 in total); upon disagreement, final decision was reached through discussion with a third reviewer. We finally identified 101 eligible articles, 23 with cardiovascular events (CVEs) and 78 with measures of subclinical atherosclerosis as end-points. The Newcastle-Ottawa scale for observational studies was used for quality assessment (all included studies had ≥6 stars).

Results: Both traditional and disease-specific risk factors were identified with independent predictive ability for clinical CHD. The most consistent traditional factors were age (particularly 48 years or in post-menopausal state), male gender, arterial hypertension, dyslipidemia and smoking. SLE factors most commonly associated with clinical CHD were overall disease activity, cumulative damage, disease duration, antiphospholipid antibodies, high sensitivity C-reactive protein and renal disease. Corticosteroids were linked to increased atherosclerotic risk; anti-malarials were shown to be protective. In regard to imaging techniques, only carotid ultrasonography for the assessment of intima-media thickness and plaque area were shown to independently predict future CVEs in lupus patients. Relative risks for CVEs for each identified risk factor are shown in the table.

 RR: relative risk, TC: total cholesterol, TG: triglycerides, aPL: antiphospholipid antibodies, IMT: intima-media thickness (carotid artery), TPA: total plaque area (carotid artery)

Conclusion: Premature CHD in lupus patients is multifactorial; modifiable traditional risk factors should be monitored initially and at frequent intervals to ensure prompt management. Disease specific factors play a key role in the atherogenetic process and should also be evaluated on a regular basis. Carotid ultrasonography holds promise in predicting cardiovascular events in SLE and should be performed in selected high-risk patients.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/optimal-monitoring-for-coronary-heart-disease-risk-in-systemic-lupus-erythematosus-patients-a-systematic-review/