Riesgo cardiovascular en el lupus eritematoso sistémico: factores implicados y métodos para su valoración

Cardiovascular disease has become the leading cause of mortality in patients with systemic lupus erythematosus (SLE). Accelerated atherosclerosis is considered one of the most important mechanisms implicated in the high cardiovascular (CV) mortality associated with SLE. Atherosclerosis in SLE patients arises from an interaction among classical CV risk factors, inflammatory mediators and factors specific to SLE itself. Consequently, calculating CV risk in these patients is central to decision-making on treatment to prevent CV disease. However, although Systematic COronary Risk Evaluation (SCORE) is recommended by The European League against Rheumatism (EULAR) experts and is widely used by rheumatologists for CV assessment in patients with rheumatoid arthritis and other forms of inflammatory arthritis, CV risk in SLE patients cannot be adequately evaluated with widely used charts for stratifying CV risk. Due to the lack of specific charts, assessment of traditional CV risk factors (smoking, blood pressure, diabetes, body mass index and lipid profile) and the use of validated imaging techniques to detect subclinical atherosclerosis have been proposed for the assessment of vascular disease in SLE patients. Among these techniques, calculating the intima-media thickness of the common carotid arteries measured in the far wall and the presence of plaques in the carotid system have become commonly used indicators of subclinical atherosclerosis. To a certain extent, the use of these methods allows individualized CV assessment and consequently a more useful management strategy, which can decrease CV mortality in SLE patients.