Division of Rheumatology, Department of Medicine, University of Padova, Italy.
Lupus. 2013 Oct;22(12):1232-42. doi: 10.1177/0961203313492871.
Patients with systemic lupus erythematosus (SLE) have a higher prevalence of clinical and subclinical atherosclerosis compared with age- and sex-matched controls. Atherosclerosis progression is also accelerated in SLE, and coronary heart disease (CHD) is a major cause of morbidity and mortality. Traditional cardiovascular (CV) risk factors, including hypertension, diabetes mellitus or dyslipidemia, are more prevalent in SLE patients than in the general population, but they cannot fully account for accelerated atherosclerosis in SLE. In fact, a number of nontraditional risk factors have been identified, including disease activity, damage and various treatments. Preventive strategies for CHD are mandatory in SLE patients and should include giving up smoking; performing regular physical activity; managing metabolic abnormalities such as dyslipidemia, insulin resistance, and diabetes; treating persistent disease activity; and minimizing chronic exposure to corticosteroids. Low-dose aspirin, angiotensin-converting enzyme (ACE) inhibitors, vitamin D supplementation, antimalarials and, when indicated, some immunosuppressants such as mycophenolate mofetil should also be considered.
系统性红斑狼疮（SLE）患者的临床和亚临床动脉粥样硬化患病率高于年龄和性别匹配的对照组。SLE 患者的动脉粥样硬化进展也加速，冠心病（CHD）是发病率和死亡率的主要原因。传统心血管（CV）危险因素，包括高血压、糖尿病或血脂异常，在 SLE 患者中比普通人群更为常见，但它们不能完全解释 SLE 中加速的动脉粥样硬化。事实上，已经确定了许多非传统危险因素，包括疾病活动、损伤和各种治疗。SLE 患者必须采取预防 CHD 的策略，包括戒烟；定期进行体育锻炼；控制血脂异常、胰岛素抵抗和糖尿病等代谢异常；治疗持续的疾病活动；并尽量减少长期接触皮质类固醇。还应考虑小剂量阿司匹林、血管紧张素转换酶（ACE）抑制剂、维生素 D 补充剂、抗疟药，以及在有指征时使用某些免疫抑制剂，如霉酚酸酯。
