Coronary artery disease is a significant cause of morbidity and premature death in patients with systemic lupus erythematosus

Systemic lupus erythematosus (SLE) is a systemic chronic disease in which impaired function of immuno-competent cells leads to inflammation and internal organ failure. In the course of SLE most patients develop cardiological complications, which are among the most dangerous complications of SLE. Cardiovascular manifestations of SLE include accelerated coronary heart disease (CHD), pericarditis, myocarditis, valvular disease, Libman–Sacks nonbacterial endocarditis (the most characteristic cardiac manifestation of SLE), conduction abnormalities , pulmonary hypertension, thromboembolic events, hypertension and heart failure. In recent years, it has been widely appreciated that premature atheroscle-rosis is a major cause of death in patients with SLE, especially in young or middle-aged women, for whom the background rate of CHD outcomes is very low. Despite improvements in overall lupus mortality, due to better possibilities of diagnosis and treatment, the risk of mortality seems to be 3 to 5 times greater in patients with SLE compared with the general population [1]. Furthermore, a large international cohort study suggested that although standardized all-cause mortality rates (SMR) for SLE decreased from 4.9 (in 1970–1979) to 2.0 (in 1990–2001), the SMR for cardiovascular disease (CVD) in SLE did not decrease over the same period [2]. An increased risk of cardiovascular events among patients with SLE has been confirmed in multiple studies. Bernatsky et al. compared the mortality in an SLE co-hort with general population mortality rates. In 23 centers , 9547 patients (90% of the patients were female) were observed for an average of 8.1 years. During the observation 1,255 deaths occurred and the most common types of deaths (313 patients) not directly attributed to SLE were deaths due to circulatory disease (including all types of heart disease, arterial disease and cerebrovascular events – strokes). The SMR for death due to circulatory disease was 1.7 (95% CI 1.5–1.9) [2]. In studies of young necropsy patients with SLE substantial atherosclerosis was present in up to half [3, 4]. Manzi et al. [5] found that women with SLE in the 35 to 44-year age group were over 50 times more likely to have a myocardial infarction (MI) compared with their healthy counterparts in the Framingham Offspring Study. The dramatic increase in CHD in young patients with SLE has been widely recognized and is an important concern of current clinical research, but the pathogenesis is still unknown. Indeed, traditional risk factors such as hyperten-sion, hypercholesterolemia, diabetes mellitus, tobacco use, obesity, family history of CHD and sedentary …