Endothelial dysfunction and vascular stiffness in systemic lupus erythematosus: Are they early markers of subclinical atherosclerosis?

In systemic lupus erythematosus (SLE), the risk of development of cardiovascular disease is dramatically increased. Inflammatory and immune-mediated mechanisms, favouring early alterations of the arterial wall are strongly involved in promoting the development of atherosclerosis (ATS) in young SLE patients. In SLE, sonographic measurements of carotid intima-media thickness are able to recognize clinical, but not always subclinical, ATS. On the contrary, assessment of endothelial function and vascular stiffness through sonography-based techniques may be useful to reveal or exclude subclinical ATS. More efforts should be done to find a comprehensive approach to the study of subclinical ATS in SLE patients, since an early diagnosis may have a significant value in preventing the development of major vascular diseases.