Nephritis, phospholipid antibodies contribute to cardiovascular risk in lupus
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DESTIN, Fla. — Nephritis and phospholipid antibodies should be considered as contributors to cardiovascular disease risk in patients with systemic lupus erythematosus, according to a speaker at the Congress of Clinical Rheumatology East.
“In my view, I think that cardiovascular disease in SLE is an enemy with two major faces,” Elisabet Svenungsson, MD, PhD, an adjunct professor from the Karolinska Institute, in Sweden, told attendees. “It’s the nephritis patients who are about 30% to 40%, at least at our center. The other face is the phospholipid antibodies.”
Patients with nephritis, Svenungsson said, typically have more atherosclerosis. Patients with SLE should be screened for phospholipid antibodies at an early age following disease detection. In addition to these risk factors, there is also a genetic association that should not be discounted, she added.
Rheumatologists should also pay special attention to lipid activity, as triglycerides increase while high-density lipoprotein is decreased in the presence of disease activity. Meanwhile, low-density lipoprotein is typically unaffected, Svenungsson said.
Due to a lack of power in many studies investigating cardiovascular outcomes in patients with SLE, traditional risk factors, such as smoking and abnormal blood lipid levels, do not always come up, Svenungsson told attendees. She added that when a traditional risk factor is present, it is typically the presence of smoking.
In addition to being aware of patients’ genetic predisposition and the potential protective impact of hydroxychloroquine, Svenungsson also stressed that rheumatologists should do their best to limit steroids.
“It’s important to minimize the steroids, and there is a genetic predisposition,” she said. Additionally, patients should be encouraged to quit smoking and maintain awareness of their hyperlipidemia and hypertension status.
Lastly, Svenungsson counseled rheumatologists to collaborate with a primary care physician to manage risk factors such as blood pressure and hypertension.
“In my practice, I screen for risk factors, but I send the patients to a general practitioner to get treatment for blood pressure or other risk factors, but I also follow up,” Svenungsson said.
“To summarize, many SLE patients die prematurely due to cardiovascular disease,” she added. “We need to remember this as doctors.”
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Svenungsson E. Cardiovascular disease in SLE: Who is at risk and how can it be prevented? Presented at: The Congress of Clinical Rheumatology East; May 12-15, 2022; Destin, Fla.
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