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Coronary heart disease in systemic lupus erythematosus

Author
Karen H Costenbader, MD, MPH
Section Editors
David S Pisetsky, MD, PhD
Heidi M Connolly, MD, FASE
Deputy Editor
Monica Ramirez Curtis, MD, MPH

INTRODUCTION

Systemic lupus erythematosus (SLE) is associated with several cardiovascular manifestations, of which accelerated atherosclerosis with coronary heart disease (CHD) is a significant cause of morbidity and premature death. The greatest increase in relative risk is extremely high among young women, who otherwise have a low risk of CHD, although the absolute risk of CHD increases with age, as it does in the general population [1-7].

Issues related to CHD in patients with SLE will be reviewed here. Other cardiac manifestations of SLE, including pericardial, myocardial, and valvular heart disease, are discussed separately. (See "Non-coronary cardiac manifestations of systemic lupus erythematosus in adults".)

EPIDEMIOLOGY

An increased prevalence of atherosclerosis is present among patients with systemic lupus erythematosus (SLE). In autopsy studies of young patients with SLE, substantial atherosclerosis was present in up to half [8,9].

A systematic review which included 28 studies found that the risk of cardiovascular disease (which included myocardial infarction, cerebrovascular disease, and peripheral vascular disease) among SLE patients is at least doubled when compared with the general population [7]. Traditional cardiovascular disease (CVD) risk factors, along with disease duration and disease activity, appear to further increase the risk. Younger patients with SLE were found to have the greatest relative risk of CVD compared with their healthy counterparts, but the absolute risk was higher in older SLE patients.

While angina and myocardial infarction are most commonly due to atherosclerosis in patients with SLE, these may rarely be due to thrombosis in an angiographically normal coronary artery or result from coronary vasculitis or arterial emboli [10]. (See "Coronary heart disease and myocardial infarction in young men and women" and "Non-coronary cardiac manifestations of systemic lupus erythematosus in adults".)

                      

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Literature review current through: Nov 2016. | This topic last updated: Fri Jan 08 00:00:00 GMT+00:00 2016.
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