Coronary Artery Disease

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Accelerated atherosclerosis in SLE, besides classical risk factors, such as age, sex, smoking, hyperlipidemia, hypertension, diabetes, hyperhomocysteinemia, cronic renal insufficiency, obesity, is related to a permanent pro-inflammatory state, long-term steroid administration and aPL.

The prevalence of aPL in patients with myocardial infarction seems to be between 5 and 15%. Elevated levels of aCL imply an increased risk for the development of myocardial infarction and recurrent cardiac events. Similar data have been described for angina.

A correlation between the levels of aCL and antibodies to oxidized LDL (anti-oxLDL) , as well as the cumulative effect of both for the risk of myocardial infarction, has been described. Anti-oxLDL antibodies have been considered as markers of atherosclerosis.

In the same way, among patients with significant aCL there is a substantial failure rate following aortocoronary venous bypass grafting, as well as high restenosis rate after percutaneous transluminal coronary angioplasty (PTCA).

Therefore, aPL general screening of ischemic cardiac disease patients is not indicated, but should be requested in case of:

  • Younger patients (age <50)
  • Those with a previous history of venous or arterial thrombosis or recurrent fetal losses
  • Those with a family history of an autoimmune disease (especially lupus)

Long-term anticoagulation is indicated in cases of aPL-related coronary artery disease.

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