Should Clinicians Start Measuring Flow Mediated Dilation Response in Patients with Systemic Lupus Erythematosus?

Premature atherosclerosis as a major cause of late mortality in systemic lupus erythematosus (SLE) was first confirmed by Urowitz and his colleagues in the 1970s1. The authors described a bimodal pattern of mortality based on a cohort of 81 patients followed for 5 years. Of the 5 patients who died late in the course of SLE, all had a myocardial infarction either close to or at the time of death. Subsequently, many studies have confirmed patients with SLE are exposed to an increased risk of cardiovascular (CV) disease2,3,4. Prevention of atherosclerosis development is an important goal in the longterm management of patients with SLE. In general, these patients are more exposed to traditional CV risk factors. For example, a higher prevalence of metabolic syndrome has been demonstrated in SLE patients than in controls5,6. Regular surveillance and prompt treatment of CV risk factors may thus improve longterm survival. In addition, there is evidence that repeated systemic inflammation plays a pivotal role in the development of CV complications in SLE7. Previous studies have shown patients with worse disease with frequent inflammatory flares are at a greater risk of developing CV disease in the long term8,9. Clearly, therefore, maintaining the patient’s disease in remission is another important preventive strategy against CV complications in SLE. Additionally, ability to predict CV disease will go a long way to improve the longterm prognosis of SLE. A number of surrogate markers have been developed to detect preclinical atherosclerosis. … Address correspondence to Dr. Lau; E-mail: cslau{at}hku.hk