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Assessment and management of the heightened risk for atherosclerotic cardiovascular events in patients with lupus erythematosus or dermatomyositis
- Source :
- International Journal of Women's Dermatology, Vol 7, Iss 5, Pp 560-575 (2021), International Journal of Women's Dermatology
- Publication Year :
- 2021
- Publisher :
- Elsevier, 2021.
-
Abstract
- For patients with lupus erythematosus (LE) or dermatomyositis (DM), there is an urgent need to address a heightened risk of clinical events, chiefly heart attacks and strokes, caused by atherosclerotic cardiovascular disease (ASCVD). Patients with LE or DM frequently exhibit high levels of conventional risk factors for ASCVD events, particularly dyslipoproteinemia and hypertension; an amplified burden of atherosclerotic plaques; and increased age- and sex-adjusted rates of ASCVD events compared with the general population. The rate of ASCVD events exceeds what would be expected from conventional risk factors, suggesting that disease-specific autoimmune processes exacerbate specific, known pathogenic steps in atherosclerosis. Importantly, despite their heightened risk, patients with LE or DM are often undertreated for known causative agents and exacerbators of ASCVD. Herein, we propose an approach to assess and manage the heightened risk of ASCVD events in patients with LE or DM. Our approach is modeled in large part on established approaches to patients with diabetes mellitus or stage 3 or 4 chronic kidney disease, which are well-studied conditions that also show heightened risk for ASCVD events and have been explicitly incorporated into standard clinical guidelines for ASCVD. Based on the available evidence, we conclude that patients with LE or DM require earlier and more aggressive screening and management of ASCVD. We suggest that physicians consider implementing multipliers of conventional risk calculators to trigger earlier initiation of lifestyle modifications and medical therapies in primary prevention of ASCVD events, employ vascular imaging to quantify the burden of subclinical plaques, and treat to lower lipid targets using statins and newer therapies, such as PCSK9 inhibitors, that decrease ASCVD events in nonautoimmune cohorts. More clinical vigilance is needed regarding surveillance, prevention, risk modification, and treatment of dyslipidemias, hypertension, and smoking in patients with LE or DM. All of these goals are achievable.
- Subjects :
- medicine.medical_specialty
Population
Lupus
Review
Dermatology
Cardiovascular
Dermatomyositis
Diabetes mellitus
medicine
In patient
PCSK9 Inhibitors
Intensive care medicine
education
Medical dermatology
Connective tissue disease
Subclinical infection
education.field_of_study
Lupus erythematosus
business.industry
autoimmune
medicine.disease
Atherosclerosis
Lipids
Cholesterol
Atherosclerotic cardiovascular disease
RL1-803
business
Kidney disease
Subjects
Details
- Language :
- English
- ISSN :
- 23526475
- Volume :
- 7
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- International Journal of Women's Dermatology
- Accession number :
- edsair.doi.dedup.....00562db519b2c0e1bd7e359e1f1576ec