hkm0202p26 - REVIEW ARTICLE GN Thomas LS Tam B Tomlinson EK...

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26 HKMJ Vol 8 No 1 February 2002 REVIEW ARTICLE Key words: Arteriosclerosis; Cardiovascular diseases; Hong Kong; Lupus erythematosus, systemic ±² ! ±² !" ±² !"# ±² ±² !"#$% Accelerated atherosclerosis in patients with systemic lupus erythematosus: a review of the causes and possible prevention Systemic lupus erythematosus is an autoimmune disorder affecting multiple organ systems. Patients with systemic lupus erythematosus exhibit a bimodal pattern of mortality, with those who have had the disease for 5 to 10 years being at increased risk of cardiovascular disease, particularly myocardial infarction. Elevated levels of conventional cardiovascular risk factors promote vascular damage resulting in impairment of normal endothelial function. In addition, autoantibodies directed against oxidised lipoproteins, along with chronic secretion of inflammatory cytokines and suppression of fibrinolytic parameters, are thought to increase atherogenesis. Treatment with corticosteroids may also contribute to the accelerated atherosclerosis observed in these patients. This review discusses the accentuated relationship between conventional cardiovascular risk factors, systemic lupus erythematosus–induced inflammatory changes, and the early stages of atherogenesis and how careful monitoring of risk factors and use of appropriate therapies may reduce the progression of atheroma development in patients with systemic lupus erythematosus. ±² !"#$%&'()*+,-±²./012345±² !"#$67. ±² !"#$%&'()*+ 5 ± 10 ±² ! "#$%&'()"*+,² ±² !"#$%&'(±²)*+,-./0!"1'(23-4 056$7 ±² !"#$%&'()*+,-./01234'567809:;<=>? ±² !"#$%&'()*+,-./0123456(789:;<=>?@ ±² !"#$%&'()*+,-./0123456789:;<=>?@A ±² !"#$%&'()*+,-.,/012345067,89:;"<= ±² !"#$%&'()*+,-./0123456789:;<=>?@A ±² !" ○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○○ GN Thomas LS Tam ±² B Tomlinson ±² EK Li ±² HKMJ 2002;8:26-32 ±² !"#$%&'()*+,-./012345(6 ±² !"# Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong GN Thomas, PhD LS Tam, MRCP B Tomlinson, MD, FRCP (Edin) EK Li, FRCP (Lond, Edin) Correspondence to: Dr LS Tam Systemic lupus erythematosus (SLE) is a systemic disease involving multiple organs that presents with a wide range of clinical manifestations and is characterised by autoantibody production. 1 The prevalence of this disorder has been reported to be four to five times higher in Hong Kong (260/100 000) than in Caucasian populations from the US (15-50/100 000) or UK (30/100 000). 1 Systemic lupus erythematosus primarily affects premenopausal (aged 16 to 55 years) females, who make up 90% of SLE cases. 1 It is uncommon in children and the elderly, but in these groups, one third of the patients are male. It has been thought that SLE carried a worse prognosis in Chinese patients, 2 but a recent study suggests that this is not the case. 3 Mortality and coronary artery disease A bimodal mortality distribution in SLE patients was first reported in the late 1970s, 4 in a small 5-year prospective study of 81 patients, of whom 11 died.
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hkm0202p26 - REVIEW ARTICLE GN Thomas LS Tam B Tomlinson EK...

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