title: [Atherosclerosis in systemic lupus erythematosus].
abstract: BACKGROUND
  Evidence from epidemiological studies demonstrates that patients with systemic lupus erythematosus (SLE) are at increased risk for the development of cardiovascular disease. Traditional cardiovascular risk factors' play an important role in this phenomenon but do not account for the entire risk in lupus patients.
  
  
  OBJECTIVE
  The incidence and prevalence of cardiovascular events and infraclinical atherosclerosis are reviewed. Combinations of traditional risk factors with lupus-specific and treatment-related variables are detailed.
  
  
  RESULTS
  Atherosclerosis is more prevalent and occurs prematurely in lupus patients. Relative risk of myocardial infarction is between 5 to 8 times greater that of general population, and may exceed 50 in women between 35 and 44 years old. SLE was also found as an independent risk factor for subclinical atherosclerosis, and more than one third of lupus patient show evidence of carotid plaques of coronary artery calcifications. Lupus patients have more frequent traditional risk factors compared with general population of similar age and sex. Besides the traditional risk factors, SLE specific risk factors have been identified among witch advanced age at diagnosis, current disease activity, duration of the disease and renal activity. Moreover, lipid abnormalities in patients with SLE are common and likely are one of the major causes of premature atherosclerosis in these patients; the dyslipoprotein associated increased triglycerides and depressed HDL-cholesterol with proinflammatory HDL production. Autoimmunity may have a part of responsibility, but data's in favour of this hypothesis are not strong. Other mechanisms such as vascular inflammation, oxidative stress, immune complexes and complement activation may also elicit endothelial damage and promote atherosclerosis are associated with the pathogenesis of both SLE and atherosclerosis. Steroids may have a true double-edged role with a pro-atherogenic risk regarding the exacerbation of metabolic risk factors and a "beneficial" anti-inflammatory role. It is becoming increasingly apparent that antimalarials treatment in SLE has an atheroprotective and a cardioprotective effect. The other immunosuppressive drugs may reduce progression of atherosclerosis and cardiovascular events but their precise role remains to be elucidated. Despite their role in primary prevention in target general population, for now, systematic prescription of statins does not show a great benefit in the cardiovascular risk in lupus patients.
  
  
  CONCLUSIONS
  Mechanisms of atherosclerosis in SLE remain elusive. It is partially explained by the interaction of traditional cardiovascular risk factors, lupus-specific factors and therapy specially corticosteroids. Management strategies of lupus should include early all those items.
authors.affiliation: Université Mohamed V Souissi, faculté de médecine et de pharmacie, Rabat, Maroc; Hôpital Ibn Sina, service de médecine interne, 1000 Rabat, Maroc. Electronic address: z.tazimezalek@gmail.com.
authors.forename: Zoubida
authors.initials: Z
authors.lastname: Tazi Mezalek
authors.affiliation: Université Mohamed V Souissi, faculté de médecine et de pharmacie, Rabat, Maroc; Hôpital Ibn Sina, service de médecine interne, 1000 Rabat, Maroc.
authors.forename: Hicham
authors.initials: H
authors.lastname: Harmouche
authors.affiliation: Université Mohamed V Souissi, faculté de médecine et de pharmacie, Rabat, Maroc; Hôpital Ibn Sina, service de médecine interne, 1000 Rabat, Maroc.
authors.forename: Wafaa
authors.initials: W
authors.lastname: Ammouri
authors.affiliation: Université Mohamed V Souissi, faculté de médecine et de pharmacie, Rabat, Maroc; Hôpital Ibn Sina, service de médecine interne, 1000 Rabat, Maroc.
authors.forename: Mouna
authors.initials: M
authors.lastname: Maamar
authors.affiliation: Université Mohamed V Souissi, faculté de médecine et de pharmacie, Rabat, Maroc; Hôpital Ibn Sina, service de médecine interne, 1000 Rabat, Maroc.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Adnaoui
authors.affiliation: AP-HP, hôpital de la Pitié-Salpêtrière, service de médecine interne, 75013 Paris, France.
authors.forename: Patrice
authors.initials: P
authors.lastname: Cacoub
mesh_terms: D050197:Atherosclerosis / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000188:drug therapy; D008297:Male; D015995:Prevalence; D012307:Risk Factors