Background: Systemic Lupus Erythematosus (SLE) is characterised by increased mortality
secondary to Cardiovascular Diseases (CVD). Despite being common in SLE, traditional
cardiovascular risk factors cannot entirely justify such increase in CVD-associated mortality. The
endothelium is a key regulator of the vascular homeostasis; lupus-associated persistent systemic
inflammation may impair endothelium functionality, thus initiating a cascade of events that, in concert
with traditional CVD-risk factors, leads to atherosclerosis development and progression. Numerous
methods have been used for the in vivo assessment of the endothelial function; among all, Flow-
Mediated Dilatation (FMD) has been widely validated in clinical trials. Quantification of the
endothelial dysfunction by FMD has been confirmed to be an early predictor of CVD in multiple
studies involving both non-CVD and CVD-population and it may therefore represent a likewise
efficient biomarker of CVD in SLE.
Methods: Research and online content related to endothelial function in SLE is reviewed in this
article with special attention to the pathophysiology and therapeutic opportunities.
Results: To date, the vast majority of the available data, albeit not all, shows that endotheliumdependent
FMD values are lower in SLE patients compared to healthy subjects; further studies,
however, will be required in order to confirm the usefulness of the endothelial dysfunction
quantification as CVD-predictor in the specific clinical setting of lupus. Notably, FMD variations can
also be a sensitive marker for assessing specific therapeutic strategies ability of improving endothelial
function in SLE patients.
Conclusion: Endothelial function appears to be affected by SLE potentially contributing to the
increased cardiovascular risk observed in SLE patients.