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Premature atherosclerosis and coronary heart disease (CHD) are long-term adverse events that occur at much greater frequency among patients with SLE than would be expected. Patients with SLE have a five- to six-fold increased risk of CHD, and in young women between 20 and 40 years, this risk is reported to be as high as 50-fold greater than peers (26). Although the actual risk of a cardiac event related to atherosclerosis is relatively low in adolescence, clearly the process of accelerated atherosclerosis may begin during this time. The etiology of early CHD in patients with SLE involves both classic risk factors as well as factors relating to disease such as chronic inflammation, autoantibodies such as antiphospholipid antibodies, and vascular perturbation by vasculitis (27). Table 2 lists risk factors for early atherosclerosis in patients with SLE. Certain classic cardiovascular disease risk factors are more common among patients with SLE, such as diabetes, hypertension, and hypercholesterolemia. This concern provides more evidence for the importance of controlling hypertension, and monitoring for elevated lipids and diabetes among adolescents with SLE.

One method of measuring the earliest development of accelerated atherosclerosis is by examining the carotid intimal-media wall thickness using sophisticated ultrasonagraphy. In one study of pediatric patients with SLE, patients were shown to have a significantly higher carotid intimal-wall thickness (IMT) compared with healthy controls (28). Children with nephrotic range proteinuria were found to have the highest IMT measurements. These data suggests that aggressive attempts should be undertaken to treat children and adolescents with nephrotic lupus nephritis, in order to help prevent later CHD.

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