cardiovascular-agents and Lupus-Erythematosus--Systemic

SLE is increasingly recognized as an important risk factor for cardiovascular disease. Premature CAD and several other cardiac manifestations are resulting in significant morbidity and premature death among young and older adults. There is a considerable unmet need for developing specific guidelines toward the primary and secondary prevention of cardiovascular disease in SLE patients.. The authors describe the prevalence of various cardiovascular manifestations, associated with traditional and lupus-specific risk factors. They summarize the evidence behind various nonpharmacological and pharmacological options such as cardiac medications, antimalarials, anti-inflammatory, and immunosuppressant medications.. There is considerable literature claiming that the traditional Framingham score used to calculate the risk in the general population would not clearly predict the 10-year risk among SLE patients as they do not include lupus-specific risk factors such as accelerated inflammation, immunometabolic changes, thrombosis, vasospasm, vasculitis, and endothelial dysfunction into account. Identifying potential risk factors among SLE patients and treating hyperlipidemia regardless of their risk scores may be the first step in reducing mortality. Blocking lupus-specific inflammatory pathways by targeting validated biomarkers of pathogenesis has great future potential and more studies are needed on their cardiovascular benefits.

Topics: Aged; Anti-Inflammatory Agents; Antimalarials; Cardiovascular Agents; Cardiovascular Diseases; Humans; Immunosuppressive Agents; Inflammation; Lupus Erythematosus, Systemic; Prevalence; Risk Factors

Patients with systemic lupus erythematosus (SLE) present an increased prevalence of coronary heart disease. The majority of cases of acute coronary syndrome (ACS) in patients with SLE are due to atherosclerosis. Less common causes include thrombosis of an angiographically normal coronary artery and coronary vasculitis. Spontaneous coronary artery dissection (SCAD) is a rare cause of ACS in these patients. We report the case of a 53-year-old female diagnosed of SLE presenting with an ACS caused by SCAD. She was treated medically and her clinical course was favorable. A literature search identified seven additional cases of SCAD associated with SLE. The main clinical features found in these reports are revised. ACS caused by SCAD in SLE patients is a condition likely under-reported in literature. SCAD should be suspected in patients with SLE and ACS, especially in younger women without evident cardiovascular risk factors. An early accurate diagnosis of SCAD is key to provide specific treatment, which differs from that of usual atherosclerotic ACS.

Topics: Acute Coronary Syndrome; Cardiovascular Agents; Coronary Vessel Anomalies; Female; Humans; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Middle Aged; Risk Factors; Treatment Outcome; Vascular Diseases

Patients with Rheumatoid Arthritis (RA) and Systemic Lupus Erythematosus (SLE) have a significantly increased risk of cardiovascular disease (CVD). The reason for this is unclear but may be due, at least in part, to the failure of endothelial repair mechanisms. Over the last 15 years there has been much interest in the mechanisms of endothelial renewal and its potential as a therapy for CVD. In the circulation there are two distinct populations of cells; myeloid angiogenic cells (MACs) which augment repair by the paracrine secretion of angiogenic factors, and outgrowth endothelial cells (OECs) which are true endothelial progenitor cells (EPCs) and promote vasculogenesis by differentiating into mature endothelium. There are marked abnormalities in the number and function of these cells in patients with RA and SLE. Inflammatory cytokines including interferon-alpha (IFNα) and tumour-necrosis factor alpha (TNFα) both impair MAC and OEC function ex vivo and may therefore contribute to the CVD risk in these patients. Whilst administration of mononuclear cells, MACs and other progenitors has improved cardiovascular outcomes in the acute setting, this is not a viable option in chronic disease. The pharmacological manipulation of MAC/OEC function in vivo however has the potential to significantly improve endothelial repair and thus reduce CVD in this high risk population.

Topics: Angiogenic Proteins; Animals; Arthritis, Rheumatoid; Cardiovascular Agents; Cardiovascular Diseases; Endothelial Cells; Humans; Immunosuppressive Agents; Inflammation Mediators; Lupus Erythematosus, Systemic; Regeneration; Stem Cell Transplantation; Stem Cells

This review focuses on events subsequent to planning a pregnancy and addresses three components of concern for women with systemic lupus erythematosus: maternal, placental, and fetal. Flare rates are generally low for patients who are clinically stable at conception. For patients who have never had renal disease, there is no frm evidence that they will develop active renal disease simply due to being pregnant. For patients who begin pregnancy with an abnormal creatinine (> 2 mg/dl is ill advised), risks include hypertension, preeclampsia, high rate of fetal loss, and possible further deterioration of renal function. Discontinuation of angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and mycophenalate is mandatory. Elevated levels of sVEGF-1 may be a harbinger of preeclampsia. For patients with anti-phospholipid antibodies detected in the frst trimester of pregnancy, the lupus anticoagulant per se may be the strongest predictor of pregnancy complications. For women with anti-SSA/Ro antibodies the risk of having a child with congenital heart block is 2% which rises to a recurrence rate of 18%. Information on current approaches to prevention and treatment of heart complications of neonatal lupus is provided.

Topics: Antibodies, Antinuclear; Cardiovascular Agents; Female; Fetus; Health Status Indicators; Heart Defects, Congenital; Humans; Kidney Diseases; Lupus Erythematosus, Systemic; Maternal-Fetal Exchange; Pregnancy; Pregnancy Complications; Pregnancy Outcome; Risk Assessment; Risk Factors; Severity of Illness Index; Steroids

Topics: Amiodarone; Anticoagulants; Antihypertensive Agents; Cardiac Glycosides; Cardiovascular Agents; Diuretics; Dose-Response Relationship, Drug; Drug Eruptions; Humans; Lupus Erythematosus, Systemic; Skin

No previous study has been done on whether systemic lupus erythematosus (SLE) disease activity is related to the hemodynamics and right ventricular (RV) function in patients with SLE-associated pulmonary artery hypertension (SLE-APAH).. This study prospectively recruited 54 patients (mean age, 32.8±8.4 years; 92.6% female) with SLE-APAH, including 34 patients with SLE disease activity index (SLEDAI) <5 (low score) and 20 with SLEDAI ≥5 (high score). All patients underwent right heart catheterization and iloprost inhalation, and echocardiography was performed before and immediately after iloprost inhalation. There was no difference in baseline mean pulmonary artery pressure (mPAP) between the 2 groups; pulmonary vascular resistance (PVR) was significantly higher and cardiac index was significantly lower in the low-SLEDAI group. The patients with low SLEDAI had larger RV size and worse RV systolic function on echocardiography. After iloprost inhalation, the patients with low SLEDAI had a greater decrease in mPAP and PVR than those with high SLEDAI, while significantly increased RV systolic function was found only in the low-SLEDAI group.. SLE activity is related to hemodynamics and RV function in SLE-APAH patients, and those with low SLEDAI might have better acute response to vasodilator inhalation.

Topics: Adult; Cardiac Catheterization; Cardiovascular Agents; Echocardiography; Female; Humans; Hypertension, Pulmonary; Iloprost; Lupus Erythematosus, Systemic; Male; Vascular Resistance; Vasodilation; Ventricular Function, Right

Systemic lupus erythematosus (SLE) is a chronic autoimmune inflammatory disease which follows a relapsing and remitting course that can manifest in any organ system. While classic manifestations consist of arthralgia, myalgia, frank arthritis, a malar rash and renal failure to name a few, cardiac tamponade, however, is a far less common and far more dangerous presentation. We highlight the case of a 61year-old male with complaints of acute onset shortness of breath and generalized body aches associated with a fever and chills in the ER. A bedside echocardiogram revealed a significant pericardial effusion concerning for pericardial tamponade. An emergent pericardiocentesis performed drained 800mL of serosanguinous fluid. While denying a history of any rash, photosensitivity, oral ulcers, or seizures, his physical examination did reveal metacarpal phalangeal joint swelling along with noted pulsus paradoxus of 15-200mmHg. Subsequent lab work revealed ANA titer of 1:630 and anti-DS DNA antibody level of 256IU/mL consistent with SLE. This case highlights cardiac tamponade as a rare but life-threatening presentation for SLE and raises the need to keep it in the differential when assessing patients presenting with pertinent exam findings.

Topics: Antihypertensive Agents; Cardiac Tamponade; Cardiovascular Agents; Chills; Diltiazem; Dyspnea; Echocardiography; Fever; Humans; Lupus Erythematosus, Systemic; Male; Metoprolol; Middle Aged; Pericardial Effusion; Pericardiocentesis; Treatment Outcome

Diastolic heart failure (DHF) remains unexplained in some patients with recurrent admissions after full investigation. A study was directed for screening SLE and systemic autoimmune connective tissue disorders in recurrent unexplained DHF patients admitted at a short-stay and intermediate care unit. It was found that systemic autoimmune conditions explained 11% from all of cases. Therapy also prevented new readmissions. Autoimmunity should be investigated in DHF.

Topics: Abortion, Habitual; Aged; Aged, 80 and over; Autoimmune Diseases; Cardiovascular Agents; Connective Tissue Diseases; Critical Care; Delayed Diagnosis; Female; Heart Failure, Diastolic; Humans; Lupus Erythematosus, Systemic; Male; Mass Screening; Middle Aged; Mitral Valve Insufficiency; Pregnancy; Prospective Studies; Recurrence; Spain

Topics: Adult; Anticoagulants; Antiphospholipid Syndrome; Biomarkers; Blood Chemical Analysis; Blood Coagulation; Blood Coagulation Tests; Cardiovascular Agents; Catastrophic Illness; Diagnosis, Differential; Electrocardiography; Humans; Immunosuppressive Agents; Ischemia; Lupus Erythematosus, Systemic; Male; Predictive Value of Tests; Severity of Illness Index; Thrombosis; Tomography, X-Ray Computed; Treatment Outcome; Vasculitis

Topics: Biopsy; Cardiac Resynchronization Therapy; Cardiomyopathies; Cardiovascular Agents; Defibrillators, Implantable; Electric Countershock; Electrocardiography; Fatal Outcome; Female; Heart Failure; Humans; Hydroxychloroquine; Immunosuppressive Agents; Lupus Erythematosus, Systemic; Middle Aged; Multiple Organ Failure; Treatment Outcome

Topics: Adrenal Cortex Hormones; Cardiovascular Agents; Dexamethasone; Glucocorticoids; Humans; Lupus Erythematosus, Systemic; Prednisolone