Сердечно-сосудистые осложнения при системной красной волчанке: механизмы ускоренного развития атеросклероза, диагностика, возможности коррекции

Сердечно-сосудистые осложнения при системной красной волчанке: механизмы ускоренного развития атеросклероза, диагностика, возможности коррекции

Автор: Аршинов А.В., Левшин Н.Ю., Маслова И.Г.

Журнал: Научно-практическая ревматология @journal-rsp

Рубрика: Обзоры

Статья в выпуске: 3 т.55, 2017 года.

Бесплатный доступ

Атеросклероз и его осложнения - главная причина поздней смертности среди пациентов с системной красной волчанкой (СКВ). СКВ и ишемическую болезнь сердца (ИБС) объединяют общие патофизиологические механизмы, связанные с системным и хроническим воспалением. В то же время традиционные факторы риска, например артериальная гипертензия, пожилой возраст, курение, гиперхолестеринемия, ожирение и мужской пол, не могут полностью объяснить механизм ускоренного развития атеросклероза у пациентов с СКВ. Наличие специфических факторов риска, таких как длительность течения, применение глюкокортикоидов, присутствие аутоантител к двуспиральной (нативной) ДНК и наличие антифосфолипидных антител, создают условия для ускорения развития атеросклероза в данной группе больных. Имеющиеся факты указывают на то, что ревматолог может понизить риск развития сердечно-сосудистых заболеваний (ССЗ), контролируя активность СКВ. Также должна проводиться коррекция традиционных факторов риска ССЗ, начиная с отказа от курения, контроля массы тела и артериального давления. Необходимо учитывать роль проводимой противовоспалительной терапии, в частности позитивное влияние таких препаратов, как противомалярийные средства и микофенолата мофетил, и прогностически неблагоприятный эффект длительного применения глюкокортикоидов. Дальнейшие исследования должны помочь разработать эффективные шкалы риска развития, конкретные терапевтические программы профилактики и лечения ССЗ у больных СКВ.

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Системная красная волчанка, атеросклероз, нетрадиционные сердечно-сосудистые факторы риска, лечение сердечно-сосудистых событий

Короткий адрес: https://sciup.org/14945824

IDR: 14945824   |   DOI: 10.14412/1995-4484-2017-304-310

Список литературы Сердечно-сосудистые осложнения при системной красной волчанке: механизмы ускоренного развития атеросклероза, диагностика, возможности коррекции

  • Насонов ЕЛ. Антифосфолипидный синдром. Москва: Литтерра; 2004. 440 с
  • EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis. 2008;67:195-205 DOI: 10.1136/ard.2007.070367
  • Liu Z, Davidson A. Taming lupus -a new understanding of pathogenesis is leading to clinical advances. Nature Medicine. 2012;18(6):871-82 DOI: 10.1038/nm.2752
  • D'Cruz DP, Khamashta MA, Hughes GR. Systemic lupus erythematosus. Lancet. 2007;369(9561):587-96 DOI: 10.1016/S0140-6736(07)60279-7
  • Rubin LA, Urowitz MB, Gladman DD. Mortality in systemic lupus erythematosus: the bimodal pattern revisited. Q J Med. 1985;55(216):87-98.
  • Urowitz MB, Bookman AA, Koehler BE, et al. The bimodal mortality pattern of systemic lupus erythematosus. Am J Med. 1976;60(2):221-5 DOI: 10.1016/0002-9343(76)90431-9
  • Bjö rnadal L, Yin L, Granath F, et al. Cardiovascular disease a hazard despite improved prognosis in patients with systemic lupus erythematosus: results from a Swedish population based study 1964
  • Nossent J, Cikes N, Kiss E, et al. Current causes of death in systemic Lupus erythematosus in Europe, 2000-2004: relation to disease activity and damage accrual. Lupus. 2007;16(5):309-17 DOI: 10.1177/0961203307077987
  • Amaya-Amaya J, Sarmiento-Monroy JC, Caro-Moreno J, et al. Cardiovascular disease in latin american patients with systemic lupus erythematosus: a cross-sectional study and a systematic review. Autoimmune Dis. 2013;2013:Article ID 794383, 20 p DOI: 10.1155/2013/794383
  • McMahon M, Skaggs B. Pathogenesis and treatment of atherosclerosis in lupus. Rheum Dis Clin North Am. 2014;40(3):475-95.
  • Van Leuven SI, van Wijk DF, Volger OL, et al. Mycophenolate mofetil attenuates plaque inflammation in patients with symptomatic carotid artery stenosis. Atherosclerosis. 2010;211(1):231-6 DOI: 10.1016/j.atherosclerosis.2010.01.043
  • Petri M. The lupus anticoagulant is a risk factor for myocardial infarction (but not atherosclerosis): Hopkins Lupus Cohort. Thromb Res. 2004;114(5-6):593-5 DOI: 10.1016/j.throm-res.2004.07.012
  • Magder LS, Petri M. Incidence of and risk factors for adverse cardiovascular events among patients with systemic lupus erythematosus. Am J Epidemiol. 2012;176(8):708-19 DOI: 10.1093/aje/kws130
  • Esdaile JM, Abrahamowicz M, Grodzicky T, et al. Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum. 2001;44(10):2331-7. doi: 10.1002/1529-0131(200110)44:103.0.CO;2-I
  • Trager J, Ward MM. Mortality and causes of death in systemic lupus erythematosus. Curr Opin Rheumatol. 2001;13:345-51 DOI: 10.1097/00002281-200109000-00002
  • Bruce IN. 'Not only.. but also': factors that contribute to accelerated atherosclerosis and premature coronary heart disease in systemic lupus erythematosus. Rheumatology (Oxford). 2005;44(12):1492-502 DOI: 10.1093/rheumatology/kei142
  • Manzi S, Meilahn EN, Rairie JE, et al. Age-specific incidence rates ofmyocardial infarction and angina in women with systemic lupus erythematosus: comparison with the Framingham study. Amer J Epidemiol. 1997;145(5):408-15 DOI: 10.1093/oxfordjour-nals.aje.a009122
  • Kiani AN, Magder LS, Petri M. Mycophenolate mofetil (MMF) does not slow the progression of subclinical atherosclerosis in SLE over 2 years. Rheumatol Int. 2012;32(9):2701-5 DOI: 10.1007/s00296-011-2048-y
  • Doria A, Iaccarino L, Ghirardello A, et al. Long-term prognosis and causes of death in systemic lupus erythematosus. Amer J Med. 2006;119(8):700-6 DOI: 10.1016/j.amjmed.2005.11.034
  • Ильина АЕ, Клюквина НГ, Александрова ЕН и др. Атеросклеротическое поражение сосудов при системной красной волчанке и антифосфолипидном синдроме у мужчин. Клиническая медицина. 2006;(4):23-8
  • McMahon M, Grossman J, Chen W, et al. Inflammation and the pathogenesis of atherosclerosis in systemic Lupus erythematosus. Lupus. 2006;15:59-69 DOI: 10.1177/0961203306071668
  • Sinicato NA, da Silva Cardoso PA, Appenzeller S. Risk factors in cardiovascular disease in systemic lupus erythematosus. Curr Cardiol Rev. 2013;19(1):15-9.
  • Narshi CB, Giles IP, Rahman A. The endothelium: an interface between autoimmunity and atherosclerosis in systemic Lupus erythematosus? Lupus. 2011;20(1):5-13 DOI: 10.1177/0961203310382429
  • Ames PR, Margarita A, Sokoll KB, et al. Premature atherosclerosis in primary antiphospholipid syndrome: preliminary data. Ann Rheum Dis. 2005;64(2):315-7 DOI: 10.1136/ard.2004.023952
  • Ames PR, Margarita A, Alves JD. Antiphospholipid antibodies and atherosclerosis: insights from systemic lupus erythematosus and primary antiphospholipid syndrome. Clin Rev Allergy Immunol. 2009;37(1):29-35 DOI: 10.1007/s12016-008-8099-5
  • Gresele P, Migliacci R, Vedovati MC, et al. Patients with primary antiphospholipid antibody syndrome and without associated vascular risk factors present a normal endothelial function. Thromb Res. 2009;123(3):444-51 DOI: 10.1016/j.thromres.2008.05.015
  • Petri M. Update on anti-phospholipid antibodies in SLE: the Hopkins' Lupus Cohort. Lupus. 2010;19(4):419-23 DOI: 10.1177/0961203309360541
  • O'Neill SG, Giles I, Lambrianides A, et al. Antibodies to apolipoprotein A-I, high-density lipoprotein, and C-reactive protein are associated with disease activity in patients with systemic lupus erythematosus. Arthritis Rheum. 2010;62(3):845-54 DOI: 10.1002/art.27286
  • Mandal K, Foteinos G, Jahangiri M, et al. Role of antiheat shock protein 60 autoantibodies in atherosclerosis. Lupus. 2005;14(9):742-6 DOI: 10.1191/0961203305lu2212oa
  • Fangtham M, Petri M. 2013 update: Hopkins lupus cohort. Curr Rheumatol Rep. 2013;15(9):360 DOI: 10.1007/s11926-013-0360-0
  • Motoki Y, Nojima J, Yanagihara M, et al. Anti-phospholipid antibodies contribute to arteriosclerosis in patients with systemic lupus erythematosus through induction of tissue factor expression and cytokine production from peripheral blood mononuclear cells. Thromb Res. 2012;130(4):667-73 DOI: 10.1016/j.thromres.2011.11.048
  • Loeffen R, Spronk HM, ten Cate H. The impact of blood coagulability on atherosclerosis and cardiovascular disease. J Thromb Haemost. 2012;10(7):1207-16 DOI: 10.1111/j.1538-7836.2012.04782.x
  • Boles J, Mackman N. Role of tissue factor in thrombosis in antiphospholipid antibody syndrome. Lupus. 2010;19(4):370-8 DOI: 10.1177/0961203309360810
  • Mayadas TN, Tsokos GC, Tsuboi N. Mechanisms of immune complex-mediated neutrophil recruitment and tissue injury. Circulation. 2009;120:2012-24 DOI: 10.1161/CIRCULATI0NA-HA.108.771170
  • Tsokos GC. Mechanisms of disease systemic lupus erythematosus. N Engl J Med. 2011;365:2110-21 DOI: 10.1056/NEJMra1100359
  • Rajagopalan S, Somers EC, Brook RD, et al. Endothelial cell apoptosis in systemic lupus erythematosus: a common pathway for abnormal vascular function and thrombosis propensity. Blood. 2004;103:3677-83 DOI: 10.1182/blood-2003-09-3198
  • Ruiz-Limon P, Barbarroja N, Perez-Sanchez C, et al. Atherosclerosis and cardiovascular disease in systemic lupus erythematosus: effects of in vivo statin treatment. Ann Rheum Dis. 2015;74(7):1450-8 DOI: 10.1136/annrheumdis-2013-204351
  • Thacker SG, Duquaine D, Park J, et al. Lupus-prone New Zealand Black/New Zealand White F1 mice display endothelial dysfunction and abnormal phenotype and function of endothelial progenitor cells. Lupus. 2010;19(3):288-99 DOI: 10.1177/0961203309353773
  • Thacker SG, Zhao W, Smith CK, et al. Type I interferons modulate vascular function, repair, thrombosis, and plaque progression in murine models of lupus and atherosclerosis. Arthritis Rheum. 2012;64(9):2975-85 DOI: 10.1002/art.34504
  • Trinchieri G. Type I interferon: friend or foe? J Exp Med. 2010;207(10):2053-63 DOI: 10.1084/jem.20101664
  • Knight JS, Kaplan MJ. Cardiovascular disease in lupus: insights and updates. Curr Opin Rheumatol. 2013;25(5):597-605 DOI: 10.1097/B0R.0b013e328363eba3
  • Brinkmann V, Reichard U, Goosmann C, et al. Neutrophil extracellular traps kill bacteria. Science. 2004;303(5663):1532-5 DOI: 10.1126/science.1092385
  • Brinkmann V, Zychlinsky A. Neutrophil extracellular traps: is immunity the second function of chromatin? J Cell Biol. 2012;198(5):773-83 DOI: 10.1083/jcb.201203170
  • Hakkim A, Furnrohr BG, Amann K, et al. Impairment of neutrophil extracellular trap degradation is associated with lupus nephritis. Proc Natl Acad Sci USA. 2010;107(21):9813-8 DOI: 10.1073/pnas.0909927107
  • Leffler J, Martin M, Gullstrand B, et al. Neutrophil extracellular traps that are not degraded in systemic lupus erythematosus activate complement exacerbating the disease. J Immunol. 2012;188(7):3522-31 DOI: 10.4049/jimmunol.1102404
  • Garcia-Romo GS, Caielli S, Vega B, et al. Netting neutrophils are major inducers of type I IFN production in pediatric systemic lupus erythematosus. Sci Transl Med. 2011;3(73):73ra20 DOI: 10.1126/scitranslmed.3001201
  • Lande R, Ganguly D, Facchinetti V, et al. Neutrophils activate plasmacytoid dendritic cells by releasing self-DNA-peptide complexes in systemic lupus erythematosus. Sci Transl Med. 2011;3(73):73ra19.
  • Villanueva E, Yalavarthi S, Berthier CC, et al. Netting neutrophils induce endothelial damage, infiltrate tissues, and expose immunostimulatory molecules in systemic lupus erythematosus. J Immunol. 2011;187(1):538-52 DOI: 10.4049/jim-munol.1100450
  • Davi G, Patrono C. Platelet activation and atherothrombosis. N Engl J Med. 2007;357(24):2482-94 DOI: 10.1056/NEJMra071014
  • Vieira-de-Abreu A, Campbell RA, Weyrich AS, et al. Platelets: versatile effector cells in hemostasis, inflammation, and the immune continuum. Semin Immunopathol. 2012;34(1):5-30 DOI: 10.1007/s00281-011-0286-4
  • Tam LS, Fan B, Li EK, et al. Patients with systemic lupus erythematosus show increased platelet activation and endothelial dysfunction induced by acute hyperhomocysteinemia. J Rheumatol. 2003;30(7):1479-84.
  • Duffau P, Seneschal J, Nicco C, et al. Platelet CD154 potentiates interferon-alpha secretion by plasmacytoid dendritic cells in systemic lupus erythematosus. Sci Transl Med. 2010;2(47):47ra63 DOI: 10.1126/scitranslmed.3001001
  • Kaiser R, Li Y, Chang M, et al. Genetic risk factors for thrombosis in systemic lupus erythematosus. J Rheumatol. 2012;39(8):1603-
  • Chang YH, Lin IL, Tsay GJ, et al. Elevated circulatory MMP-2 and MMP-9 levels and activities in patients with rheumatoid arthritis and systemic lupus erythematosus. Clin Biochem. 2008;41(12):955-9 DOI: 10.1016/j.clinbiochem.2008.04.012
  • Bahrehmand F, Vaisi-Raygani A, Kiani A, et al. Matrix metalloproteinase-2 functional promoter polymorphism G1575A is associated with elevated circulatory MMP-2 levels and increased risk of cardiovascular disease in systemic Lupus erythematosus patients. Lupus. 2012;21(6):616-24 DOI: 10.1177/0961203312436857
  • McMahon M, Grossman J, Skaggs B, et al. Dysfunctional proin-flammatory high-density lipoproteins confer increased risk of atherosclerosis in women with systemic lupus erythematosus. Arthritis Rheum. 2009;60(8):2428-37 DOI: 10.1002/art.24677
  • Zampieri S, Iaccarino L, Ghirardello A, et al. Systemic lupus erythematosus, atherosclerosis, and autoantibodies. Ann N Y Acad Sci. 2005;1051:351-61 DOI: 10.1196/annals.1361.077
  • Kawai VK, Solus JF, Oeser A, et al. Novel cardiovascular risk prediction models in patients with systemic Lupus erythematosus. Lupus. 2011;20(14):1526-34 DOI: 10.1177/0961203311420317
  • Symmons DPM, Gabriel SE. Epidemiology of CVD in rheumatic disease, with a focus on RA and SLE. Nat Rev Rheumatol. 2011;7(7):399-408 DOI: 10.1038/nrrheum.2011.75
  • Urowitz MB, Gladman D, Ibanez D, et al. Atherosclerotic vascular events in a multinational inception cohort of systemic lupus erythematosus. Arthritis Care Res (Hoboken). 2010;62:881-7 DOI: 10.1002/acr.20122
  • Schoenfeld SR, Kasturi S, Costenbader KH. The epidemiology of atherosclerotic cardiovascular disease among patients with SLE: a systematic review. Semin Arthr Rheum. 2013;43(1):77-95 DOI: 10.1016/j.semarthrit.2012.12.002
  • Genest J, McPherson R, Frohlich J, et al. 2009 Canadian Cardiovascular Society/Canadian guidelines for the diagnosis and treatment of dyslipidemia and prevention of cardiovascular disease in the adult -2009 recommendations. Can J Cardiol. 2009;25(10):567-79 DOI: 10.1016/S0828-282X(09)70715-9
  • Ridker PM, MacFadyen J, Cressman M, et al. Efficacy of rosuvastatin among men and women with moderate chronic kidney disease and elevated high-sensitivity C-reactive protein: a secondary analysis from the JUPITER (Justification for the Use of Statins in Prevention-an Intervention Trial Evaluating Rosuvastatin) trial. J Am Coll Cardiol. 2010;55(12):1266-73 DOI: 10.1016/j.jacc.2010.01.020
  • Pons-Estel GJ, Gonzalez LA, Zhang J, et al. Predictors of cardiovascular damage in patients with systemic lupus erythematosus: data from LUMINA (LXVIII), a multiethnic US cohort. Rheumatology (Oxford). 2009;487:817-22 DOI: 10.1093/rheumatology/kep102
  • Gustafsson J, Simard JF, Gunnarsson I, et al. Risk factors for cardiovascular mortality in patients with systemic lupus erythematosus, a prospective cohort study. Arthritis Res Ther. 2012;14(2):46 DOI: 10.1186/ar3759
  • Nikpour M, Harvey PJ, Ibanez D, et al. High-sensitivity C-reactive protein as a marker of cardiovascular risk in systemic lupus erythematosus. Arthritis Rheum. 2012;64(9):3052-3 DOI: 10.1002/art.34541
  • Wu GC, Liu HR, Leng RX, et al. Subclinical atherosclerosis in patients with systemic lupus erythematosus: A systemic review and meta-analysis. Autoimmun Rev. 2016;15(1):22-37 DOI: 10.1016/j.autrev.2015.10.002
  • Tselios K, Sheane BJ, Gladman DD, Urowitz MB. Optimal monitoring for coronary heart disease risk in patients with systemic lupus erythematosus: A systematic review. J Rheumatol. 2016;43(1):54-65 DOI: 10.3899/jrheum.150460
  • Petri M, Magder L. SLE cardiovascular risk equation. Lupus. 2013;22(1):3-5.
  • Jastrzebska M, Czok ME, Guzik P. Autoimmune diseases, their pharmacological treatment and the cardiovascular system. Cardiol J. 2013;20(6):569-76 DOI: 10.5603/CJ.2013.0156
  • Fardet L. Corticosteroid-induced clinical adverse events: Frequency, risk factors and patient's opinion. Br J Dermatol. 2007;157:142-8 DOI: 10.1111/j.1365-2133.2007.07950.x
  • Nakajima A, Doki K, Homma M, et al. Investigation of glucocorticoidinduced side effects in patients with autoimmune diseases. Yakugaku Zasshi. 2009;129:445-50 DOI: 10.1248/yakushi.129.445
  • Linos E, Fiorentino D, Lingala B. Atherosclerotic cardiovascular disease and ermatomyositis: an analysis of the Nationwide Inpatient Sample survey. Arthritis Res Ther. 2013;15:1-5 DOI: 10.1186/ar4135
  • Tisseverasinghe A, Bernatsky S, Pineau C. Arterial events in persons with dermatomyositis and polymyositis. J Rheumatol. 2009;36:1-4 DOI: 10.3899/jrheum.090061
  • Selzer F, Sutton-Tyrrell K, Fitzgerald S, et al. Vascular stiffness in women with systemic lupus erythematosus. Hypertension. 2001;37(4):1075-82 DOI: 10.1161/01.HYP.37.4.1075
  • Roman MJ, Shanker BA, Davis A, et al. Prevalence and correlates of accelerated atherosclerosis in systemic lupus erythematosus. N Engl J Med. 2003;349(25):2399-406 DOI: 10.1056/NEJMoa035471
  • Rahman P, Gladman DD, Urowitz MB, et al. The cholesterol lowering effect of antimalarial drugs is enhanced in patients with lupus taking corticosteroid drugs. J Rheumatol. 1999;26(2):325-30.
  • Jung H, Bobba R, Su J, et al. The protective effect of antimalarial drugs on thrombovascular events in systemic lupus erythematosus. Arthritis Rheum. 2010;62(3):863-8 DOI: 10.1002/art.27289
  • Law G, Magder LS, Fang H, et al. Hydroxychloroquine Reduces Thrombosis (BOTH ARTERIAL AND VENOUS) in Systemic LUPUS Erythematosus, Particularly in Antiphospholipid Positive Patients. American College of Rheumatology 76th Annual Meeting; November 9-14, 2012. Washington, D.C.; 2012.
  • Linos E, Fiorentino D, Lingala B. Atherosclerotic cardiovascular disease and ermatomyositis: an analysis of the Nationwide Inpatient Sample survey. Arthritis Res Ther. 2013;15:1-5 DOI: 10.1186/ar4135
  • Costedoat-Chalumeau N, Hulot JS. Heart conduction disorders related to antimalarials toxicity: an analysis of electrocardiograms in 85 patients treated with hydroxychloroquine for connective tissue diseases. Rheumatology. 2007;46:808-10 DOI: 10.1093/rheumatology/kel402
  • Iudici M, Fasano S, Gabriele Falcone L, et al. Low-dose aspirin as primary prophylaxis for cardiovascular events in systemic lupus erythematosus: a long-term retrospective cohort study. Rheumatology (Oxford). 2016;55(9):1623-30. /kew231 DOI: 10.1093/rheumatology
  • Van Leuven SI, Mendez-Fernandez YV, Wilhelm AJ, et al. Mycophenolate mofetil but not atorvastatin attenuates atherosclerosis in lupus-prone LDLr(-/-) mice. Ann Rheum Dis. 2012;71(3):408-14 DOI: 10.1136/annrheumdis-2011-200071
  • Mason JC, Libby P. Cardiovascular disease in patients with chronic inflammation: mechanisms underlying premature cardiovascular events in rheumatologic conditions. Eur Heart J. 2015;36(8):482-9 DOI: 10.1093/eurheartj/ehu403
  • Aprahamian T, Bonegio RG, Richez C, et al. The peroxisome pro-liferator-activated receptor gamma agonist rosiglitazone ameliorates murine lupus by induction of adiponectin. J Immunol. 2009;182(1):340-6 DOI: 10.4049/jimmunol.182.1.340
  • Zhao W, Thacker SG, Hodgin JB, et al. The peroxisome proliferatoractivated receptor gamma agonist pioglitazone improves cardiometabolic risk and renal inflammation in murine lupus. JImmunol. 2009;183(4):2729-40 DOI: 10.4049/jimmunol.0804341
  • Zuarez-Rojas JG, Medina-Urrutia AX, Jorge-Galarza E, et al. Pioglitazone improves the cardiovascular profile in patients with uncomplicated systemic Lupus erythematosus: a double-blind randomized clinical trial. Lupus. 2012;21(1):27-35 DOI: 10.1177/0961203311422096
  • Khattri S, Zandman-Goddard G. Statins and autoimmunity. Immunol Res. 2013;56(2-3):348-57 DOI: 10.1007/s12026-013-8409-8
  • Willis R, Seif AM, McGwin G Jr, et al. Effects of statins on proin-flammatory/prothrombotic biomarkers and on disease activity scores in SLE patients: data from LUMINA (LXXVI), a multiethnic US cohort. Clin Exp Rheumatol. 2014;32(2):162-7.
  • Lawman S, Mauri C, Jury EC, et al. Atorvastatin inhibits autoreactive B cell activation and delays lupus development in New Zealand black/white F1 mice. J Immunol. 2004;173(12):7641-6 DOI: 10.4049/jimmunol.173.12.7641
  • Aprahamian T, Bonegio R, Rizzo J, et al. Simvastatin treatment ameliorates autoimmune disease associated with accelerated atherosclerosis in a murine lupus model. J Immunol. 2006;177(5):3028-34. DOI: 10.4049/jimmunol.177.5.3028
  • Petri MA, Kiani AN, Post W, et al. Lupus Atherosclerosis Prevention Study (LAPS). Ann Rheum Dis. 2011;70:760-5 DOI: 10.1136/ard.2010.136762
  • Schanberg LE, Sandborg C, Barnhart HX, et al. Use of atorvastatin in systemic lupus erythematosus in children and adolescents. Arthritis Rheum. 2012;64(1):285-96 DOI: 10.1002/art.30645
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