University Clinic for Cardiology, Medical Faculty, Ss' Cyril and Methodius University, Skopje, North Macedonia.
Institute for Pathophysiology and Nuclear Medicine, Medical Faculty, Ss' Cyril and Methodius University, Skopje, North Macedonia.
Curr Pharm Des. 2021;27(29):3221-3228. doi: 10.2174/1381612826666201210110809.
Accelerated atherosclerosis is widely present in patients with systemic lupus erythematosus.
The aim of this review was to analyze the relationship between systemic lupus erythematosus and cardiovascular diseases, with the emphasis on acute myocardial infarction.
We conducted a literature review through PubMed and Cochrane, using keywords: SLE, atherosclerosis, atherothrombosis, coronary artery disease, myocardial infarction, prognosis, sex specifics.
Various molecular mechanisms triggered by infection/inflammation are responsible for endothelial dysfunction and the development of atherosclerosis at an earlier age. A contributing factor is the cumulative effect of traditional cardiovascular risk factors interaction with disease-related characteristics. Myocardial infarction rates are 2- to 10-fold higher compared to the general population. Young women have the highest relative risk, however, men carry at least 3-fold higher risk than women. Coronary involvement varies from normal coronary artery with thrombosis, coronary microartery vasculitis, coronary arteritis, and coronary atherosclerosis. Typical clinical presentation is observed in men and older women, while atypical is more frequent in young women. Treatment is guided by the underlying mechanism, engaging invasive procedures alone, or accompanied with immunosuppressive and/or anti-inflammatory therapy. There are significant gender differences in pathophysiology and clinical presentation. However, they receive the same therapeutic treatments.
Systemic lupus erythematosus is a major contributor to atherosclerotic and non-atherosclerotic mechanisms involved in the development of myocardial infarction, which should be taken into account during therapeutic treatment. Although systemic lupus erythematosus per se is a "female" disease, males are at increased cardiovascular risk and worse outcomes.
系统性红斑狼疮患者广泛存在动脉粥样硬化。
本综述旨在分析系统性红斑狼疮与心血管疾病的关系，重点分析急性心肌梗死。
我们通过 PubMed 和 Cochrane 进行文献回顾，使用的关键词为：SLE、动脉粥样硬化、动脉血栓形成、冠状动脉疾病、心肌梗死、预后、性别特异性。
感染/炎症引发的各种分子机制可导致内皮功能障碍和更早发生动脉粥样硬化。一个促成因素是传统心血管危险因素的累积效应与疾病相关特征相互作用。与普通人群相比，心肌梗死发生率高 2 至 10 倍。年轻女性的相对风险最高，然而男性的风险比女性高至少 3 倍。冠状动脉受累表现为正常冠状动脉伴血栓形成、冠状动脉微血管炎、冠状动脉炎和冠状动脉粥样硬化。典型临床表现见于男性和老年女性，而非典型表现则更常见于年轻女性。治疗方案取决于潜在机制，单独采用有创操作，或联合免疫抑制和/或抗炎治疗。在病理生理学和临床表现方面存在显著的性别差异。然而，她们接受的治疗方法是相同的。
系统性红斑狼疮是参与心肌梗死发生的动脉粥样硬化和非动脉粥样硬化机制的主要因素，在治疗过程中应予以考虑。尽管系统性红斑狼疮本身是一种“女性”疾病，但男性的心血管风险更高，预后更差。
