Background: Accelerated atherosclerosis is widely present in patients with systemic lupus erythematosus.
Objective: The aim of this review was to analyze the relationship between systemic lupus erythematosus and
cardiovascular diseases, with the emphasis on acute myocardial infarction.
Methods: We conducted a literature review through PubMed and Cochrane, using keywords: SLE, atherosclerosis,
atherothrombosis, coronary artery disease, myocardial infarction, prognosis, sex specifics.
Results: Various molecular mechanisms triggered by infection/inflammation are responsible for endothelial
dysfunction and the development of atherosclerosis at an earlier age. A contributing factor is the cumulative effect
of traditional cardiovascular risk factors interaction with disease-related characteristics. Myocardial infarction
rates are 2- to 10-fold higher compared to the general population. Young women have the highest relative
risk, however, men carry at least 3-fold higher risk than women. Coronary involvement varies from normal coronary
artery with thrombosis, coronary microartery vasculitis, coronary arteritis, and coronary atherosclerosis.
Typical clinical presentation is observed in men and older women, while atypical is more frequent in young
women. Treatment is guided by the underlying mechanism, engaging invasive procedures alone, or accompanied
with immunosuppressive and/or anti-inflammatory therapy. There are significant gender differences in
pathophysiology and clinical presentation. However, they receive the same therapeutic treatments.
Conclusion: Systemic lupus erythematosus is a major contributor to atherosclerotic and non-atherosclerotic
mechanisms involved in the development of myocardial infarction, which should be taken into account during
therapeutic treatment. Although systemic lupus erythematosus per se is a “female” disease, males are at increased
cardiovascular risk and worse outcomes.