Clinical and pathogenetic accents of the cardiovascular comorbidity in systemic lupus erythematosus

Ye.D. Yehudina, I.Yu. Golovach, O.O. Khaniukov


The increased incidence of cardiovascular events and subclinical atherosclerosis, confirmed by imaging and vascular function, are proven facts in systemic lupus erythematosus (SLE). Although traditional cardiovascular disease factors, such as smo-
king, dyslipidemia, diabetes mellitus, hypertension, central obesity and hyperhomocysteinemia, are common in patients with SLE, they do not fully explain the high level of ischemic events that have been reported so far, which implies that other factors that are inherent in the disease itself may contribute to an increased risk, including duration of the disease, its activity and chronic course, psychosocial factors, drugs, genetic disorders and altered immunological mechanisms. Although the exact pathogenesis of atherosclerosis in SLE remains poorly understood, the imbalance between endothelial damage and atheroprotection appears to be a central event. Factors leading to endothelial damage in SLE include oxidized low-density lipoproteins (LDL), autoantibodies to endothelial cells and phospholipids, interferons (IFN) type I and neutrophil extracellular traps that act directly or through activation of the type I IFN pathway. Increased oxidative stress, decreased levels of high-density antioxidant lipoproteins (HDL), elevated levels of pro-inflammatory HDL and decreased paraoxonase activity have been associated with elevated levels of oxidized LDL. On the other hand, disorders of atheroprotective mechanisms in SLE include a decrease in the ability of endothelial repair, partially mediated through type I IFN, and a decrease in the production of atheroprotective autoantibodies. This review summarizes the traditional and disease-related risk factors for cardiovascular diseases in chronic autoimmune disorders, with a special focus on SLE.


cardiovascular diseases; systemic lupus erythematosus; atherosclerosis; immune dysregulation; risk factors; arterial hypertension


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