Cardiovascular risk assessment in patients with systemic lupus erythematosus – between traditional and immunological factors

Abstract

Background. Systemic lupus erythematosus (SLE) is strongly associated with increased cardiovascular (CV) risk, due to both traditional risk factors and disease - specific immune mechanisms such as endothelial dysfunction and antiphospholipid antibodies. Early and personalized assessment is essential. Objective(s). To evaluate current evidence about the prevalence and mechanisms of CV risk in patients with SLE, with a focus on disease-specific immunological factors and their implications for clinical practice. Materials and methods. A narrative review of the recent literature was conducted, including articles published between 2014 and 2023. Clinical studies and meta-analyses investigating the incidence of cardiovascular events in patients with Systemic Lupus Erythematosus, as well as both traditional and disease-specific risk factors, were analyzed. Results. Patients with SLE have an increased risk of myocardial infarction and stroke, up to 50 times higher in women under 50 compared to the general population. In addition to traditional risk factors (hypertension, obesity), autoimmune mechanisms such as antiphospholipid antibodies, immune-mediated endothelial dysfunction, and neutrophil activation play a key role in atherogenesis. Standard cardiovascular risk scores tend to underestimate the real risk in systemic lupus erythematosus. Current discussions emphasize the need for more sensitive screening tools and early, individualized interventions targeting modifiable risk factors. Conclusion(s). SLE significantly increases cardiovascular risk through traditional factors and disease-specific autoimmune mechanisms. Standard assessments often underestimate this risk, making personalized monitoring and early interventions essential to prevent complications and improve patient outcomes.