Managing Cardiovascular Risk in Systemic Lupus Erythematosus: Considerations for the Clinician

Figures & data

Figure 1 Risk factors for the development of atherosclerotic disease in systemic lupus erythematosus.

Table 1 Overview of Cardiac Imaging Modalities in SLE and Associated Risk Factors

	Atherosclerotic Assessment	Associated Risk Factors
FMD	Non-invasive High-frequency ultrasound Measures endothelial dysfunction through assessment of flow-mediated dilatation that is endothelium dependent	Age BMI >30 Arterial hypertension Low HDL Oxidative LDL
Pulse wave velocity (PWV)	Non-invasive Assesses vascular stiffness as a surrogate for atherosclerosis	Age BMI >30 Arterial hypertension Male sex Elevated triglycerides Metabolic syndrome Diabetes mellitus Hypertension
Intima media thickness (IMT) and Carotid plaque	Non-invasive High-frequency ultrasound IMT inversely related to PWV	Age BMI >30 Arterial hypertension Male sex Smoking Family history Waist circumference Metabolic syndrome Diabetes mellitus Diastolic blood pressure Total cholesterol and triglyceride level Low HDL or pro-inflammatory HDL Increased serum C3 SLE duration Elevated homocysteine
Coronary artery calcification	Non-invasive Coronary CT angiography Described by the Agatston score	AGE BMI >30 Arterial hypertension Male sex Smoking Metabolic syndrome Diabetes mellitus Elevated total cholesterol and triglycerides Elevated homocysteine
Coronary Angiogram	Invasive “Gold standard” Assesses obstructive disease	Age Arterial hypertension Male sex Elevated total cholesterol and HDL
Myocardial SPECT	Non-invasive Percentage of patient with perfusion deficits without associated disease seen on angiogram	Arterial hypertension Diabetes Elevated total cholesterol and HDL Anti-phospholipid antibodies
Cardiac MR	Non-invasive Adenosine-stress perfusion deficits indicate CHD Late gadolinium enhancement confers increased risk of future events	Arterial hypertension Dyslipidemia Anti-phospholipid antibodies
PET Scan	Non-invasive Assess systemic and vascular inflammation Assesses inflammation and micro-calcification