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Accelerated atheroma in lupus—background

The University of Toronto Lupus Clinic, Centre for Prognosis Studies in The Rheumatic Diseases, Rheumatic Disease Unit, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada; Centre for Prognosis Studies in The Rheumatic Diseases, Rheumatic Disease Unit, The Toronto Hospital, Western Division, 399 Bathurst St, Room MP1-318, Toronto, Ontario, Canada M5T 2S8

D D Gladman

The University of Toronto Lupus Clinic, Centre for Prognosis Studies in The Rheumatic Diseases, Rheumatic Disease Unit, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada

Observational cohort studies in SLE have led to the description of accelerated atherosclerosis as an important cause of mortality and morbidity in this disease. The clinical observation of coronary artery disease occurring in premenopausal females with SLE gave rise to the concept of the bimodal mortality pattern. This pattern was confirmed in autopsy and epidemiological studies. These studies identified hypercholesterolemia and particularly its persistence in the first three years of disease, hypertension, and lupus itself as important risk factors for the development of accelerated atherosclerosis in these patients. It also became evident that corticosteroid therapy plays an important role in the elevation of plasma lipids while antimalarials resulted in a reduction of plasma cholesterol, LDL, and VLDL, especially in steroid-induced hyperlipidemia. Studies of clinical outcomes for atherosclerotic disease (angina, myocardial infarction) have shown a prevalence of 6-12% in a number of SLE cohorts. However, more sensitive investigations including myocardial perfusion imaging and carotid ultrasound have demonstrated a prevalence of atherosclerotic disease in 40% of patients studied. Further studies of SLE disease process, including immunological factors, may more clearly define the pathogenesis of accelerated atherosclerosis in patients with SLE, and may help elucidate mechanisms of atherosclerosis in the general population.

Key Words: lupus • accelerated atherosclerosis

Lupus, Vol. 9, No. 3, 161-165 (2000)
DOI: 10.1191/096120300678828271


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