Understanding Accelerated Atherosclerosis in Systemic Lupus Erythematosus: Toward Better Treatment and Prevention

• Published in: Inflammation 2021-10, Vol.44 (5), p.1663-1682
• Main Authors: Reiss, Allison B., Jacob, Benna, Ahmed, Saba, Carsons, Steven E., DeLeon, Joshua
• Format: Article
• Language: English
• Subjects: Adrenal Cortex Hormones - therapeutic use; Arteriosclerosis; Atherosclerosis; Atherosclerosis - blood; Atherosclerosis - epidemiology; Atherosclerosis - prevention & control; Autoantibodies - blood; Biomarkers - blood; Biomedical and Life Sciences; Biomedicine; Cardiovascular diseases; Cardiovascular Diseases - blood; Cardiovascular Diseases - epidemiology; Cardiovascular Diseases - prevention & control; Cell- and Tissue-Based Therapy - methods; Cholesterol; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Immunology; Inflammation; Inflammation Mediators - blood; Internal Medicine; Lupus; Lupus Erythematosus, Systemic - blood; Lupus Erythematosus, Systemic - epidemiology; Lupus Erythematosus, Systemic - therapy; Medical innovations; Morbidity; Pathology; Pharmacology/Toxicology; Review; Rheumatology; Risk Factors; Sex Factors; Systemic lupus erythematosus; Triglycerides
• ISSN: 0360-3997; 1573-2576
• DOI: 10.1007/s10753-021-01455-6

Systemic lupus erythematosus (SLE) carries a significant risk of cardiovascular disease (CVD). The prevalence of premature CVD is especially noteworthy because it occurs in premenopausal women with SLE who would otherwise have very low rates of CVD. While traditional risk factors likely play a role in development of CVD in the setting of SLE, they do not fully explain the excess risk. The pathogenesis of CVD in SLE is not fully understood, but the inflammatory nature of SLE is believed to be a key factor in accelerating atherosclerosis. Systemic inflammation may lead to an abnormal lipid profile with elevated triglycerides, total cholesterol, and low-density lipoprotein cholesterol and dysfunctional high-density lipoprotein cholesterol. Additionally, the inflammatory milieu of SLE plasma promotes endothelial dysfunction and vascular injury, early steps in the progression of atherosclerotic CVD. Despite the overall headway that has been achieved in treating lupus, innovative therapeutics specifically targeting the progression of atherosclerosis within the lupus population are currently lacking. However, there have been advancements in the development of promising modalities for diagnosis of subclinical atherosclerosis and detection of high CVD risk patients. Due to the significant impact of CVD on morbidity and mortality, research addressing prevention and treatment of CVD in SLE needs to be prioritized. This review explores the intricate interplay of SLE-specific properties that contribute to atherosclerosis and CVD within this population, as well as screening methods and possible therapies.