|
| Risk factor associated with CVD | Comments | Reference(s) |
|
| Traditional |
| Hypertension | Hypertension influences the risk of death by CVD in SLE patients. | [64, 89] |
| Hypertension acts as CVD subphenotype as well as a risk factor. | [45, 49, 71, 88] |
| Patients with SLE were at increased risk of thrombosis when it is associated with hypertension. | [17, 80, 84] |
| Compared with patients without atherosclerotic plaque, those with plaque had higher prevalence of hypertension. | [54, 63, 66, 73] |
| Lupus patients with abnormal myocardial scintigraphic findings and hypertension, as a risk factor for CAD, had a higher risk of abnormal findings on coronary angiography. | [52, 53] |
| Patients with lupus had higher hypertension prevalence than controls with noninflammatory disorders. | [14, 68, 90] |
| T2DM | T2DM influence on abnormal myocardial perfusion in asymptomatic patients with SLE. | [53] |
| Alterations in glycemic profile were associated with traditional risk factors for CHD and lupus characteristics, including CVD, damage index, and renal involvement. | [17, 68, 81] |
| Patients with SLE and T2DM were at increased risk of thrombosis. This risk remains elevated throughout the course of the disease. | [16, 80] |
| T2DM is an independent risk factor for atherosclerotic plaque and CAC. | [63, 71, 84] |
| Dyslipidemia | The main risk factor for death in SLE was heart involvement, which was influenced by dyslipidemia. | [50, 89] |
| High levels of TGL were associated with myocardial perfusion abnormalities and endothelial dysfunction | [52, 53, 83] |
| There was high prevalence of dyslipidemia as risk factor for thrombotic events. | [60, 62, 80] |
| Alterations in lipid profile was a risk factor for premature CAC in young women with SLE. | [66, 84] |
| CAD was more prevalent in dyslipidemic women with SLE than controls. | [64, 81] |
| Compared with patients without atherosclerotic plaque, those with plaque had high level of TGL and LDL. | [58, 63] |
| Male gender | Male gender was a risk factor for developing severe organ damage (CVD) and mortality in SLE patients. | [16, 17, 53, 60] |
| Males with SLE were at increased risk of thrombosis and CAC. This risk remains elevated throughout the course of the disease. | [80, 84, 85] |
| Patients had more peripheral vascular and gonadal involvement compared with published data from non-Hispanic SLE populations. | [76] |
| MetS | SLE patients had a high prevalence of MetS that directly contributes to increasing inflammatory status and oxidative stress. | [69] |
| MetS was associated with traditional risk factors for CHD and lupus characteristics, including CVD, damage Index, and renal involvement. | [68, 81] |
| Presence of MetS was related to CVD in SLE patients. | [90, 94] |
| Obesity | Patients with SLE who had excess weight present distinct clinical-laboratory findings, sociodemographic characteristics, and treatment options when compared to normal weight patients. | [17, 71, 81] |
| Excess weight is associated with some traditional risk factors for CVD and SLE poor prognosis. | [58, 65, 68] |
| Increase weight influence on abnormal myocardial perfusion in asymptomatic patients with SLE. | [53, 64] |
| SLE patients with high BMI have increased QT interval parameters when compared to controls. This prolongation may lead to an increased CV risk. | [55] |
| Major values in BMI were related with the presence of CAD and carotid plaque. | [58, 63, 64] |
| Smoking | Smoking is an important determinant in the occurrence of thrombotic (central and/or peripheral, arterial and/or venous) events in SLE patients. | [18, 69, 81] |
| Smoking was an independent risk factor for atherosclerotic plaque and thrombosis. | [63, 68, 80] |
| Smoking habit influence on abnormal myocardial perfusion in asymptomatic patients with SLE. | [53] |
| Smoking was a risk factor for premature CAC in young women with SLE. | [66, 84] |
| CAD was more prevalent in women with SLE. | [64, 85, 86] |
| Advance age | Several traditional risk factors, including age, appear to be important contributors to atherosclerotic CV damage. | [16, 71] |
| The presence of CVD has been associated with older age. | [16, 59] |
| Age was directly related with atherosclerotic plaque formation. | [63] |
| Menopausal status | High percentage of SLE patients with abnormal angiographic findings was in postmenopausal status. | [52] |
| There is high prevalence of premature menopausal status as a risk factor for CVD. | [60] |
| Postmenopausal status was a risk factor for premature CAC in young women with SLE. | [66, 68, 84] |
| Postmenopausal women had a higher prevalence of subclinical AT and abnormal myocardial perfusion in asymptomatic patients with SLE. | [53, 63] |
| Family history of CVD | Familial history of CVD was an independent risk factor for atherosclerotic process. | [17, 63, 68] |
| Family history of CVD was a risk factor for premature CAC in young women with SLE. | [66, 84] |
| Family history of CVD influence on abnormal myocardial perfusion in asymptomatic patients with SLE. | [53] |
| HRT | HRT use was not associated with the occurrence of vascular arterial events in the LUMINA patients. HRT use in women with SLE should be individualized, but data suggest its use may be safe if aPL antibodies are not present or vascular arterial events have not previously occurred. | [17] |
| Hyperhomocysteinemia | Hyperhomocysteinemia was a risk factor for CAC in SLE patients. | [84] |
| The presence of polyautoimmunity and hyperhomocysteinemia was risk factors for thrombotic events. | [41] |
|
| Nontraditional |
| Genetic determinants | | |
| Ancestry | There are several differences regarding clinical (including CVD), prognostic, socioeconomic, educational, and access to medical care features in GLADEL cohort according to ancestry (White, Mestizo, and African-LA). | [14] |
| Non-HLA | An SNP in FGG rs2066865 demonstrated association with arterial thrombosis risk in Hispanic Americans patients with SLE. | [87] |
| The CRP GT20 variant is more likely to occur in African-American and Hispanic SLE patients than in Caucasian ones, and SLE patients carrying the GT20 allele are more likely to develop vascular arterial events (LUMINA multiethnic cohort). | [86] |
| SLE-associated | | |
| Poliautoimmunity | The presence of APS was the major independent contributor to the development of severe organ damage in Brazilian patients with SLE. | [54] |
| APS and its characteristic antibodies may contribute to the development of thrombotic events in Brazilian and Mexican lupus patients. | [57, 78] |
| APS had high impact in CVD and survival in Brazilian lupus patients. | [42] |
| Polyautoimmunity (APS) may suggest concerted pathogenic actions with other autoantibodies in the development of thrombotic events in Mexican patients with SLE. | [78] |
| SLE per se | SLE diagnosis was significantly associated with carotid plaque formation and development of CV event in Brazilian patients with SLE. | [58] |
| High percentage of patients with abnormal angiographic findings had higher ACR criteria number for SLE Brazilian patients with SLE. | [52] |
| Autoantibodies | One of the independent predictors of vascular events in a multiethnic US cohort (LUMINA) was the presence of any aPL antibody. | [17] |
| anti-β2GPI antibodies were strongly associated with thrombosis in patients with Mexicans with SLE. The decrease of anti-β2GPI levels at the time of thrombosis may indicate a pathogenic role. | [77] |
| The higher frequency of aPT found in Mexican patients with SLE with thrombosis may suggest concerted pathogenic actions with other autoantibodies in the development of thrombotic events. | [78] |
| Patients with aCL antibodies seem to be at an increased risk for arterial and venous thrombotic events in Puerto Ricans and Chilean patients with SLE. | [92, 96] |
| There was correlation between lupus anticoagulant and thrombotic events in Brazilian lupus patients. | [50] |
| aCL antibodies were associated with thrombotic events, mainly in high titers in Chilean SLE patients. | [96] |
| aCL antibodies were significantly associated with CV events and showed an association with echocardiographic abnormalities in Brazilian patients with SLE. | [51] |
| Mexican patients had more peripheral vascular compared with published data from non-Hispanic SLE populations. | [76] |
| Immune cells aberrations | Complement fixing activity of aCL antibodies seems to be relevant in thrombotic venous events in Brazilian patients with SLE. | [57] |
| Inflammatory markers | Increased ESR was independently associated with MetS in Puerto Ricans lupic patients. | [94] |
| One of the independent predictors of vascular events in a multiethnic US cohort (LUMINA) was elevated serum levels of CRP. | [16, 17] |
| Endogenous dyslipidemia | HDL distribution and composition (−HDL2b, +HDL3b, and +HDL3c) were abnormal in noncomplicated Mexican SLE patients. | [79] |
| Low HDL levels and increased TGL levels were associated with atherosclerosis by cIMT measurement in Colombian lupic patients. | [95] |
| SLE patients have a lipid profile abnormality in Brazilian patients with SLE. This pattern of dyslipoproteinemia may increase the risk of developing CAD. | [47] |
| Disease activity | Disease activity (SLAM) is an important determinant in the occurrence of thrombotic (central and/or peripheral, arterial, and/or venous) events in the LUMINA cohort. | [18] |
| SLEDAI scores were positively correlated with BMI and WC in Brazilian population with SLE. | [69] |
| Higher disease activity was independently associated with MetS and thrombosis in Puerto Ricans and Mexican SLE patients. | [80, 94] |
| Higher score of SLICC was associated with atherosclerotic plaque in Brazilian SLE patients. | [58] |
| High scores in diseases activity index (SLEDAI and SLICC) were associated with myocardial perfusion abnormalities in Brazilian SLE patients. | [52] |
| Brazilian SLE patients have a lipid profile abnormality which is aggravated by disease activity and may reside in a defect of VLDL metabolism. | [47] |
| Disease activity was predictor of CAC in Mexican SLE patients. | [84] |
| Higher disease activity was independently associated with MetS in Puerto Ricans patients with SLE. | [94] |
| Organ damage | Baseline and accrued damage increase mortality risk (including due to CVD) in Brazilian patients with SLE. | [61] |
| Mexican patients had more peripheral vascular involvement (measured by SDI), compared with published data from non-Hispanic SLE populations. | [76] |
| In Brazilian SLE patients, MetS was associated with both traditional risk factors for CHD and lupus characteristics including damage index. | [68] |
| There was a correlation between IMT and revised damage index (SLICC) in Brazilian SLE patients. | [58] |
| Atherosclerotic CV damage in SLE is multifactorial, and disease-related factors (including CRP levels and SDI at baseline) appear to be important contributors to such an occurrence (LUMINA multiethnic cohort). | [16] |
| Long duration | Longer duration of SLE was associated with atherosclerotic plaque and CV events in Brazilian population. | [58, 59] |
| A correlation between IMT and duration of the disease was found in Brazilian patients with SLE. | [63] |
| Disease duration was independent predictor for premature CAC in young Brazilian women with SLE. | [66] |
| Medications | PDN > 10 mg/day was independently associated with MetS in Puerto Ricans SLE patients. | [94] |
| In Brazilian SLE patients, there was a correlation between IMT and the duration of PDN use. | [63] |
| IHD was observed in two types of Mexican SLE patients: those with long-term steroid therapy and those with frank episodes of vasculitis. | [73] |
| Vasculopathy | Current vasculitis was associated with abnormal myocardial scintigraphy in Brazilian patients with SLE. | [53] |
| Puerto Ricans patients with SLE and RP seem to be at increased risk for arterial and venous thrombotic events. | [92] |
| IHD was observed in two types of Mexican SLE patients: those with long-term steroid therapy and those with frank episodes of vasculitis. | [73] |
| Renal involvement | In Brazilian SLE patients, MetS was associated with traditional risk factors for CHD and lupus characteristics, including damage index and renal involvement (nephritic syndrome). | [68] |
| Miscellaneous | | |
| BMD | Decreased BMD was an independent predictor for premature CAC in Brazilian young women with SLE. | [66] |
| Sociodemographic factors | A low education and monthly income were associated with MetS in Mexican patients with SLE and RA. | [81] |
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