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Research ArticleArticle

Optimal Monitoring For Coronary Heart Disease Risk in Patients with Systemic Lupus Erythematosus: A Systematic Review

Konstantinos Tselios, Barry J. Sheane, Dafna D. Gladman and Murray B. Urowitz
The Journal of Rheumatology January 2016, 43 (1) 54-65; DOI: https://doi.org/10.3899/jrheum.150460
Konstantinos Tselios
From the University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.
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Barry J. Sheane
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Dafna D. Gladman
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Murray B. Urowitz
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  • For correspondence: m.urowitz@utoronto.ca
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Abstract

Objective. Premature coronary heart disease (CHD) significantly affects morbidity and mortality in systemic lupus erythematosus (SLE). Several studies have detected factors influencing the atherosclerotic process, as well as methods to quantify the atherosclerotic burden in subclinical stages. The aim of this systematic review was to identify the minimum investigations to optimally monitor CHD risk in SLE.

Methods. English-restricted literature review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines through Ovid Medline, Embase, and Cochrane Central databases, from inception until May 2014 (Medline until October 2014). Specific search terms included, among others, “SLE,” “atherosclerosis,” “CHD,” “myocardial ischemia,” “acute coronary syndrome,” “myocardial infarction,” and “angina pectoris.” We identified 101 eligible articles, 23 with cardiovascular events (CVE) as endpoints and 78 with measures of subclinical atherosclerosis. The Newcastle-Ottawa scale was used for quality assessment.

Results. Certain traditional and disease-specific factors were identified as independent predictors for CHD. Among the former were age (particularly postmenopausal state), male sex, arterial hypertension, dyslipidemia, and smoking. Disease activity and duration, cumulative damage, antiphospholipid antibodies, high sensitivity C-reactive protein, and renal disease were the most consistent disease-related factors. Corticosteroids were linked to increased CHD risk whereas antimalarials were protective. Concerning imaging techniques, carotid ultrasonography (intima-media thickness and plaque) was shown to independently predict CVE.

Conclusion. Premature CHD in SLE is multifactorial; modifiable variables should be monitored at frequent intervals to ensure prompt management. Disease-specific factors also affect the atherogenic process and should be evaluated regularly. Carotid ultrasonography may hold promise in predicting CVE in selected high-risk patients.

Key Indexing Terms:
  • SYSTEMIC LUPUS ERYTHEMATOSUS
  • ATHEROSCLEROSIS
  • CORONARY HEART DISEASE
  • RISK FACTORS
  • Accepted for publication August 28, 2015.
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The Journal of Rheumatology: 43 (1)
The Journal of Rheumatology
Vol. 43, Issue 1
1 Jan 2016
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Optimal Monitoring For Coronary Heart Disease Risk in Patients with Systemic Lupus Erythematosus: A Systematic Review
Konstantinos Tselios, Barry J. Sheane, Dafna D. Gladman, Murray B. Urowitz
The Journal of Rheumatology Jan 2016, 43 (1) 54-65; DOI: 10.3899/jrheum.150460

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Optimal Monitoring For Coronary Heart Disease Risk in Patients with Systemic Lupus Erythematosus: A Systematic Review
Konstantinos Tselios, Barry J. Sheane, Dafna D. Gladman, Murray B. Urowitz
The Journal of Rheumatology Jan 2016, 43 (1) 54-65; DOI: 10.3899/jrheum.150460
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Keywords

SYSTEMIC LUPUS ERYTHEMATOSUS
ATHEROSCLEROSIS
CORONARY HEART DISEASE
RISK FACTORS

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Keywords

  • SYSTEMIC LUPUS ERYTHEMATOSUS
  • ATHEROSCLEROSIS
  • CORONARY HEART DISEASE
  • RISK FACTORS

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