Application of a nomogram for exercise capacity in women with systemic lupus erythematosus
The prognosis of systemic lupus erythematosus (SLE) has improved over the past few decades. A combination of factors have contributed to this improvement, including early diagnosis of milder forms of SLE, judicious use of treatments such as glucocorticoids and immunosuppressive agents, widespread use of hydroxychloroquine, use of renal replacement therapy, and improved management of comorbidities associated with the disease.1 Further to increases in the long-term survival of patients with SLE, the late occurrence of atherosclerotic vascular disease (ASVD) has become apparent. The increased frequency of ASVD was first demonstrated by a case series,2 and evidence was supported further by prospective cohort studies.3 Patients with SLE are 5–8 times more likely to develop premature coronary heart disease (CHD), defined as age of CHD onset <55 years,3 compared with the general population with symptomatic CHD, which has an incidence of 6–10% in several SLE cohorts.4,5 The causative mechanisms leading to ASVD remain to be elucidated, although the disease itself, glucocorticoid use, and/or conventional risk factors for ASVD have all been implicated as contributing factors. Traditional risk factors and the Framingham risk factor equation underestimate the cardiovascular risk in patients with SLE. CHD-associated events in these patients have been shown to have one fewer conventional risk factor per CHD event than age-matched non-SLE patients with premature CHD.1 Moreover, adjusting results to exclude the effect of the Framingham risk factors showed that patients with SLE still had an increased risk of CHD (relative risk [RR] 7.5) and stroke (RR 7.9), which indicates that SLE itself constitutes an independent risk factor for the development of CHD.6 Patients with SLE who have sustained classical risk factors for CHD, such as hypercholesterolemia, might be at increased risk of developing CHD. In fact, SLE patients with sustained hypercholesterolemia for the first 3 years of their disease had a significantly higher proportion of CHD events than those with either Should all patients with systemic lupus erythematosus receive cardioprotection with statins?