Risk of Coronary Artery Disease in Patients With Systemic Lupus Erythematosus: A Systematic Review and Meta-analysis

Background: The association between chronic inflammation and the accelerated development of atherosclerosis is well recognized. However, it remains controversial as to whether the risk of coronary artery disease (CAD) is elevated in patients with systemic lupus erythematosus (SLE). The objective of this meta-analysis was to obtain a better estimate of the risk of CAD in patients with SLE. Methods: An English-restricted literature review was conducted according to PRISMA guidelines using key databases, surveying all articles published through October 31, 2017. Specific search terms included "SLE" and "coronary artery disease" as well as appropriate MeSH terms. The Newcastle-Ottawa scale was used for quality assessment. Results: Nine studies were identified and included in this meta-analysis. The pooled risk ratio of CAD in patients with SLE was 3.39 (95% CI: 2.15-5.35). The statistical heterogeneity of this meta-analysis was high, with an 12 value of 79.5%. An elevated risk of CAD was consistently observed in both female and male SLE patients (pooled risk ratio: 3.27 [95% CI: 2.01-5.30] and 3.16 [95% CI: 2.02-4.94], respectively). Conclusions: SLE patients are at significantly higher risk of developing CAD. However, as relatively few studies were available for incorporation into this meta-analysis, there is a clear need for further studies with larger sample sizes that better parse gender-related differences in CAD susceptibility among SLE patients. Future work to standardize cardiovascular risk factor identification and monitoring in SLE patients is also needed.