title: Optimal Monitoring For Coronary Heart Disease Risk in Patients with Systemic Lupus Erythematosus: A Systematic Review.
abstract: OBJECTIVE
  Premature coronary heart disease (CHD) significantly affects morbidity and mortality in systemic lupus erythematosus (SLE). Several studies have detected factors influencing the atherosclerotic process, as well as methods to quantify the atherosclerotic burden in subclinical stages. The aim of this systematic review was to identify the minimum investigations to optimally monitor CHD risk in SLE.
  
  
  METHODS
  English-restricted literature review was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines through Ovid Medline, Embase, and Cochrane Central databases, from inception until May 2014 (Medline until October 2014). Specific search terms included, among others, "SLE," "atherosclerosis," "CHD," "myocardial ischemia," "acute coronary syndrome," "myocardial infarction," and "angina pectoris." We identified 101 eligible articles, 23 with cardiovascular events (CVE) as endpoints and 78 with measures of subclinical atherosclerosis. The Newcastle-Ottawa scale was used for quality assessment.
  
  
  RESULTS
  Certain traditional and disease-specific factors were identified as independent predictors for CHD. Among the former were age (particularly postmenopausal state), male sex, arterial hypertension, dyslipidemia, and smoking. Disease activity and duration, cumulative damage, antiphospholipid antibodies, high sensitivity C-reactive protein, and renal disease were the most consistent disease-related factors. Corticosteroids were linked to increased CHD risk whereas antimalarials were protective. Concerning imaging techniques, carotid ultrasonography (intima-media thickness and plaque) was shown to independently predict CVE.
  
  
  CONCLUSIONS
  Premature CHD in SLE is multifactorial; modifiable variables should be monitored at frequent intervals to ensure prompt management. Disease-specific factors also affect the atherogenic process and should be evaluated regularly. Carotid ultrasonography may hold promise in predicting CVE in selected high-risk patients.
authors.affiliation: From the University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; B.J. Sheane, MD, MB, BSc, BAO, Clinical Research Fellow, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Professor of Medicine, Senior Scientist, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Senior Scientist, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Tselios
authors.affiliation: From the University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; B.J. Sheane, MD, MB, BSc, BAO, Clinical Research Fellow, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Professor of Medicine, Senior Scientist, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Senior Scientist, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital.
authors.forename: Barry J
authors.initials: BJ
authors.lastname: Sheane
authors.affiliation: From the University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; B.J. Sheane, MD, MB, BSc, BAO, Clinical Research Fellow, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Professor of Medicine, Senior Scientist, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Senior Scientist, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital.
authors.forename: Dafna D
authors.initials: DD
authors.lastname: Gladman
authors.affiliation: From the University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital, Toronto, Ontario, Canada.K. Tselios, MD, PhD, Clinical Research Fellow, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; B.J. Sheane, MD, MB, BSc, BAO, Clinical Research Fellow, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; D.D. Gladman, MD, FRCPC, Professor of Medicine, Senior Scientist, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital; M.B. Urowitz, MD, FRCPC, Professor of Medicine, Senior Scientist, University of Toronto Lupus Clinic, Centre for Prognosis Studies in the Rheumatic Diseases, University Health Network, Toronto Western Hospital. m.urowitz@utoronto.ca.
authors.forename: Murray B
authors.initials: MB
authors.lastname: Urowitz
mesh_terms: D000328:Adult; D017677:Age Distribution; D059168:Carotid Intima-Media Thickness / Q000009:adverse effects*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D018836:Inflammation Mediators / Q000097:blood; D008180:Lupus Erythematosus, Systemic / Q000453:epidemiology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
chemical_list: D018836:Inflammation Mediators
keywords: ATHEROSCLEROSIS; CORONARY HEART DISEASE; RISK FACTORS; SYSTEMIC LUPUS ERYTHEMATOSUS