Inflammation-mediated rheumatic diseases and atherosclerosis

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Abstract
Women with SLE have a high incidence of coronary heart disease.1-4 Several investigators have convincingly shown that women with SLE under the age of 45 are at substantially increased risk of ischaemic heart disease.1 4 We reported that women with SLE aged 35–44 were over 50 times more likely to have a myocardial infarction than were women of similar age from a population based sample (rate ratio = 52.43, 95% CI 21.6 to 98.5).1In contrast, women with SLE in the 45–64 year age group were only two to four times more likely to have a myocardial infarction than women without SLE of the same age. We also found a small decline in the incidence rates for myocardial infarction in women with SLE aged 45–54 compared with those having the same diagnosis aged 35–44. The reasons for this are unclear. A difference in overall survival is an unlikely explanation as mortality rates from all causes were not significantly different between women in these two age strata. A plausible hypothesis may be the prothrombotic effects of oestrogen in combination with the generally more common renal disease and associated hypertension in the younger women, and a relatively protective effect of declining oestrogen levels in women aged 45–54. Similarly, Ward reported that women with SLE aged 18–44 were 2.27 (95% CI 1.08 to 3.46) times more likely to be admitted to hospital with an acute myocardial infarction than young women without the disease.4 This increased risk of admission to hospital with ischaemic heart disease for women with SLE compared with women without the disease diminished substantially with increasing age. Whether vasculopathy is more common in younger women with SLE owing to age related differences in clinical manifestations of SLE is uncertain. Nevertheless, it is clear that young women with SLE who should be otherwise protected from ischaemic heart disease are at the highest risk.