I. What cardiovascular diseases can occur in patients with SLE, and which are the most important ones? SLE can extensively involve many organs and systems throughout the body, including, of course, the cardiovascular system. Various parts of the heart can be involved, and in serious cases, they can even be life-threatening, for example: 1. Pericardium: It is the outermost envelope of the heart. Pericarditis and pericardial effusion are among the most common manifestations in patients with lupus. When the amount of effusion is large, it can restrict the diastolic function of the heart, causing symptoms such as swelling, chest tightness, breath-holding and low blood pressure; 2. Myocardium: Myocardium is the main component of the heart, providing power for the heart to pump blood throughout the body. A small number of lupus patients can develop myocarditis leading to a decrease in the contractile function of the heart, causing heart failure in severe cases. 3. Conduction system: It is the “circuit” in the heart that controls the orderly and coordinated movement of all parts of the heart. In a few lupus patients, myocardial lesions in the conduction system and vascular lesions supplying the conduction system can lead to various arrhythmias, and serious malignant arrhythmias can be life-threatening and cause sudden cardiac death. 4. Coronary arteries: supply blood and oxygen to various parts of the heart. Many lupus patients with long-term disease can cause early-onset coronary atherosclerosis due to various mechanisms, leading to vascular stenosis and occlusion, causing myocardial ischemia and infarction. 5. Heart valve: It is a “one-way valve” inside the heart, ensuring that blood always flows forward during heart contraction. Many patients with lupus can develop various valve incompleteness and stenosis, resulting in a significant decrease in forward blood flow, causing systemic organ ischemia and heart failure; patients can also form sterile redundancies on the valves, which can easily fall off and drift away with the blood flow, thus blocking tiny blood vessels and causing ischemia and infarction of limbs and internal organs. 6. Arterial vascular: The “main artery” that supplies blood from the heart to all important organs of the body. The most common is atherosclerosis, which can cause ischemia and necrosis of the supplying organs and tissues in severe cases. In rare cases, lupus patients may develop lesions of the arterial vessel wall that cause the arteries to dilate into aneurysms or even tear the arterial wall. Among these lesions, pericardial effusion is the most common and has become one of the diagnostic criteria for lupus. As the survival time of lupus patients increases, atherosclerosis is increasingly becoming an important issue that rheumatologists often need to face during clinical consultations. II. What is atherosclerosis? What are the dangers of atherosclerosis? Atherosclerosis is a localized accumulation of cholesterol and other lipids on the inner surface of arteries, resulting in yellow atheromatous plaque-like thickening, mainly affecting the aorta, coronary arteries, cerebral arteries, renal arteries and blood supplying arteries of other important organs and tissues. Although the progression of atherosclerotic lesions is slow, it will eventually lead to excessive narrowing of the lumen of blood vessels, insufficient local blood supply or complete blockage and interruption, or the formation of local thrombosis, causing ischemia and hypoxia, dysfunction and even life-threatening to these vital organs. The danger of atherosclerosis is mainly determined by the severity of the vascular lesion and the degree of ischemia in the affected organs. Aortic atherosclerosis is often asymptomatic; coronary atherosclerosis can cause angina pectoris, myocardial infarction, arrhythmia and even sudden death if the narrowing of the diameter exceeds 75%; cerebral atherosclerosis can cause vertigo, headache and stroke, and in the later stage of brain atrophy, there can be amnesia and dementia; renal atherosclerosis often causes increased urine output at night, intractable hypertension, and in severe cases, renal failure. Atherosclerosis of mesenteric arteries may manifest as abdominal pain after a full meal, blood in stool and other symptoms; atherosclerosis of lower limb arteries causing severe narrowing of the lumen may cause intermittent claudication, disappearance of dorsalis pedis artery pulsation, and even ischemia, blackening and necrosis of fingers and toes in severe cases. Why do SLE patients develop atherosclerosis more easily and earlier than the general population? Clinically, we may encounter cases of young girls with SLE having sudden stroke or myocardial infarction, which are usually found in the elderly. According to domestic and international studies in the past 10 years or so, the incidence of atherosclerosis is higher in patients with SLE than in the general population, and the age of onset is earlier. Research data show that the total incidence of cardiovascular accidents in SLE patients is 8.5%, about 6 times that of non-lupus patients with the same risk factors (such as smoking and high blood lipids); among them, the incidence of acute myocardial infarction is about 8 to 9 times; the total incidence of stroke is 10.6%, about 10 times that of non-lupus patients. The reasons for this are: 1. Patients with SLE are more prone to the traditional risk triggers of atherosclerosis, for example, the incidence of hypertension (33%), diabetes mellitus (5%), menopause (38%), and renal insufficiency (38%) is significantly higher in these patients than in the general population; lupus nephritis and hormone use make patients have increased blood lipids; many patients are chronically bedridden and lack exercise because of decreased physical strength and joint lesions Many patients are bedridden and lack exercise because of decreased physical strength and joint lesions. The study found that 53% of lupus patients had more than three of the above risk factors. 2. The basic pathological feature of SLE is systemic vascular inflammation, and the large number of inflammatory cells and inflammatory factors makes the inner wall of blood vessels of patients vulnerable to inflammation and prone to earlier development of atherosclerosis. It has also been observed clinically that the longer the duration of lupus, the more severe the disease, and the longer the application of hormones and immunosuppressive agents, the higher the incidence of atherosclerosis. In addition, some lupus patients have antiphospholipid antibodies, which make the blood have the tendency to form blood clots and also aggravate the ischemic manifestations caused by atherosclerosis. Does atherosclerosis affect the condition and life expectancy of SLE patients? With the improvement of diagnosis and treatment methods, the 10-year survival rate of SLE patients has now reached 90%. As mortality due to disease activity declines in the early stages of lupus and patients survive longer, early onset and rapidly progressive atherosclerosis has replaced renal failure and lupus encephalopathy as one of the leading causes of death in patients with lupus. Research data show that SLE patients are 2.97 times more likely to die from cardiovascular disease than normal people; 3.03 times more likely to die from coronary heart disease, especially in the 20-39 age group where the mortality rate from coronary heart disease is the highest, up to 16 times higher; and 2.06 times more likely to die from stroke. Therefore, if atherosclerosis is not detected and treated early, it will affect the survival rate and life expectancy of SLE patients; on the contrary, if the problem is attended to and treated early, it will enable patients to live further longer and improve their quality of life. V. How can atherosclerosis be detected early in patients with SLE? Rheumatologists should increase awareness of the dangers of atherosclerosis in lupus patients and be more alert to dangerous symptoms. All patients diagnosed with lupus erythematosus should be fully evaluated for risk factors for the development of atherosclerosis, such as asking about the presence of tobacco and alcohol habits, measuring blood pressure, testing blood lipids, blood sugar/urine glucose, kidney function, etc., and also evaluating the presence of arterial ischemia in all important organs. Lipids: increased total cholesterol, triglycerides, LDL and decreased HDL are all associated with the development of atherosclerosis; lipoprotein A is one of the risk factors for the development of carotid atherosclerosis. High-sensitivity C-reactive protein: its increased level is a predictor of the occurrence of cardiovascular accidents. Electrocardiogram: It is an essential tool for screening coronary atherosclerosis and myocardial ischemia. Patients with angina pectoris and myocardial infarction can rapidly show characteristic changes on electrocardiogram. In addition, ECG can also show abnormal lesions such as pericardial effusion and arrhythmia, and has become a routine clinical examination method. Carotid artery vascular ultrasound: Carotid artery can be used as a window to reflect atherosclerosis, and monitoring of carotid artery atherosclerosis can predict the possibility of cardiovascular accidents in the future. The use of carotid vascular ultrasound can detect carotid intima and intima thickness and find carotid atheromatous plaque as a sign of atherosclerosis, which directly reflects the process of atherosclerotic vascular lesions, and patients with higher carotid intima thickness are at increased risk of cardiovascular accidents. Vascular ultrasound: It can help determine the blood flow patency of extremity arteries, renal arteries and mesenteric arteries, and can be performed when necessary for patients with ischemic symptoms in the corresponding areas. Arteriography: It is the “gold standard” for the diagnosis of atherosclerosis, which can directly visualize the diseased vessels, evaluate the degree of stenosis, and if necessary, perform direct balloon dilation and arterial stent implantation for the occluded areas. However, this test is expensive and invasive, so it is only recommended when clinicians think it is necessary. How should SLE patients prevent and treat early onset of atherosclerosis? 1. Actively control the activity of lupus disease: Patients should first go to the rheumatology and immunology department of regular hospitals, control the disease as soon as possible, strictly follow the medical advice to take medication, and closely follow up to adjust the medication plan. Avoid long-term high-dose glucocorticoid use as much as possible under the premise of ensuring the stability of the disease. Recent studies suggest that hydroxychloroquine may have some preventive effect on thrombosis. Long-term oral aspirin should also be given to patients with combined antiphospholipid syndrome. 2 General treatment: Patients with smoking, alcoholism, obesity and lack of exercise should first improve their dietary structure and lifestyle, quit smoking and alcohol, eat a low-fat diet and control total dietary calories, and insist on moderate physical activity. Reasonable arrangements for work and life. Patients with hypertension should have their blood pressure tested regularly, adjust their antihypertensive drug regimen and take medication regularly for a long time; patients with hyperlipidemia should take lipid-lowering drugs, such as statins, if necessary; patients with diabetes should actively take diet control and glucose-lowering drugs, and should take insulin treatment decisively when there is damage to vital organs. 4, timely consultation when dangerous symptoms appear: because the organ ischemia caused by atherosclerosis can suddenly worsen and deteriorate, quickly causing serious consequences or even life-threatening (such as stroke, myocardial infarction, gangrene of the limbs, etc.), so once patients repeatedly or suddenly appear chest tightness, chest pain, nausea, sweating, hand and foot weakness, salivation at the corners of the mouth, finger/toe pain, chills and other symptoms, should immediately go to the hospital emergency Do not delay the time of diagnosis and treatment.