TY - JOUR T1 - Cardiovascular Outcomes in Systemic Lupus Erythematosus: Big Studies for Big Questions JF - The Journal of Rheumatology JO - J Rheumatol SP - 467 LP - 469 DO - 10.3899/jrheum.090015 VL - 36 IS - 3 AU - SAHENA HAQUE AU - IAN N. BRUCE Y1 - 2009/03/01 UR - http://www.jrheum.org/content/36/3/467.abstract N2 - Accelerated atherosclerosis is now a well recognized complication of systemic lupus erythematosus (SLE). The overall risk of clinical coronary heart disease (CHD) in women with SLE is estimated to be between 5 and 6-fold greater than in women in the general population1. The prevalence of CHD in lupus cohorts is 6%–10%, and this has remained constant over the last 2 decades1–4. The premature onset of CHD in SLE is also well documented, with the age of first event noted on average to be between 47 and 51 years1,4–6. Several factors contribute to clinical and subclinical CHD in SLE including “classic” Framingham risk factors and SLE-related factors. The Framingham risk factor formula has been shown not to perform as well in SLE compared to a non-SLE cohort for the prediction of coronary events7. A complex interaction involving traditional risk factors, endothelial dysfunction, systemic inflammation, and therapy such as corticosteroids, renal disease and antiphospholipid antibodies is hypothesized to result in accelerated atherosclerosis in SLE. It remains unclear to what extent these risk factors contribute to the risk of CHD and to CHD-related outcomes in SLE.Overall survival in patients with SLE has improved substantially over the last 50 years, with 5-year survival estimates improving from 50% in the 1950s to 93% in 1993 in North American cohorts8,9. The improvement in survival is likely to reflect several factors. Survival rates in the general population have improved, and recognition of SLE and its complications is better and may have resulted in identifying a higher proportion of milder … Address reprint requests to Dr. Bruce. E-mail: ian.bruce{at}manchester.ac.uk ER -