A 35-year-old woman with a medical history of systemic lupus erythematosus (SLE) and hypertension presents to her PCP’s office with localized midsternal chest pain and subjective dyspnea. She has a significant family history of SLE with both of her sisters being diagnosed with SLE early in life. Her symptoms are poorly controlled despite being on hydroxychloroquine and prednisone 20 mg daily. She was recently admitted for an acute lupus flair with significant generalized pain. Her heart rate is 132, respiratory rate 24, blood pressure is 192/114, and oxygen saturation of 98% on room air. She is advised by her PCP to go to the emergency department. Upon arrival, her ECG shows concerning ST changes, cardiology is consulted and recommends a cardiac catheterization.
Which of the following is a lupus patient at significant risk for?
- A) Aortic aneurysm
- B) Coronary vasculitis
- C) Tamponade
- D) Atherosclerosis
- E) Migraines
SLE patients are at a significant risk of developing coronary artery disease due to premature atherosclerosis, in addition to chronic inflammation, chronic steroid use, and common cardiac risk factors such as hypertension, hyperlipidemia, and diabetes. Compared to women in the same age group, lupus patients have approximately a 50-fold increase in developing coronary artery disease. It is a major cause of death for this patient population.
Key Learning Point
Premature atherosclerosis is the most frequent cause of coronary artery disease is SLE patients. The prevalence of coronary artery disease among women with SLE between the ages of 35 and 44 years is at least 50-fold greater than among age-matched control subjects.
Dr. Raj Dasgupta