Management for cardiovascular features of SLE
Ideally, all people with SLE should be taking oral hydroxychloroquine and receiving counselling about the importance of reducing their cardiovascular risk. Discuss with the patient:
- stopping tobacco smoking
- regular monitoring for optimal management of blood pressure (below 130/80 mmHg)Drosos, 2022
- optimal management of diabetes
- minimising systemic corticosteroid dosage without causing a flare of SLEKostopoulou, 2020
- lipid-lowering therapy, depending on their overall cardiovascular risk.
A large retrospective cohort study1 of 220158 people with SLE suggested angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor blockers (ARB) may provide greater cardiovascular protection for people with SLE than other antihypertensive drugs (eg diuretics, calcium channel blockers, beta blockers). These results were independent of whether the person had lupus nephritisHurst, 2023. For more information about optimal management of blood pressure, see Hypertension and blood pressure reduction, and for consideration of lipid-lowering therapy, see Lipid modification.
Pharmacological management for vasculitis associated with SLE is determined by the organ(s) involved and the severity of inflammation.
Urgently refer patients with severe organ- or life-threatening vasculitis to a specialist centre for management. Immunomodulatory drugs are usually required (eg high-dose systemic corticosteroids, azathioprine). See Other immunomodulatory drugs for SLE for more information on which drugs are used in SLE.
For information about Raynaud phenomenon and associated digital ischaemia, see the separate topic, Raynaud phenomenon and digital ischaemia.