Systemic Lupus Erythematosus
The epidemiology of atherosclerotic cardiovascular disease among patients with SLE: A systematic review

https://doi.org/10.1016/j.semarthrit.2012.12.002Get rights and content
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Abstract

Objective

To perform a systematic review of the literature regarding the epidemiology of the association between systemic lupus erythematosus (SLE) and atherosclerotic cardiovascular disease (CVD), including the increased risk for CVD, as well as the risk factors responsible for development of CVD in patients with SLE.

Methods

We followed the PRISMA guidelines to systematically search the PubMed database from inception to June 2012. Studies were selected using predefined eligibility criteria, and 2 authors independently extracted data. The risk of bias was measured for each study using a domain-based assessment.

Results

We report on 28 studies that met criteria for inclusion in our analysis. We found strong epidemiologic evidence that SLE patients have an increased relative risk of CVD compared to controls. There is limited information regarding relative CVD mortality risks among SLE patients. Traditional CVD risk factors, including age, male sex, hyperlipidemia, smoking, hypertension, and CRP, are associated with CVD risk among SLE patients. Several SLE-specific factors, including disease activity and duration, and possibly specific manifestations and therapies, further increase risk. Several risk factors, such as disease activity and glucocorticoid use, are closely associated, making it difficult to disentangle their effects.

Conclusions

CVD risk among SLE patients compared to the general population is at least doubled. While older SLE patients appear to have the highest absolute risks of CVD, young women have alarmingly high relative risks, given the rarity of CVD in the comparison general population. Both traditional and SLE-specific risk factors are important, although there are discrepancies within the literature.

Abbreviations

CABG
coronary artery bypass grafting
CAD
coronary artery disease
CHF
congestive heart failure
CRP
C-reactive protein
CV
cardiovascular
CVD
cardiovascular disease
CVA
cerebrovascular accident
MI
myocardial infarction
PVD
peripheral vascular disease
SLE
systemic lupus erythematosus

Keywords

Systemic lupus erythematosus
Atherosclerosis
Cardiovascular
Coronary artery disease
Myocardial infarction
Epidemiology
Risk factors
Cohort study
Risk

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