The increased cardiovascular burden in patients with SLE is now well recognised and represents a significant cause of mortality and morbidity in these conditions. Recent studies continue to highlight the excess burden of cardiovascular disease in SLE and this continues to be a problem almost 40 years after its first description. A number of studies have also highlighted the importance of studying sub-clinical markers of cardiovascular risk as these might help us to better understand the pathogenesis of accelerated arthrosclerosis in lupus.

We have recently focussed attention on the development of metabolic syndrome in the context of SLE as this is an interesting model of future cardiovascular risk. The presence of metabolic syndrome in the general population is associated with an excess risk of future coronary heart disease and we have noted that metabolic syndrome is more common in patients with SLE. Recent work from a large international cohort has also demonstrated that corticosteroid therapy contributes to the development of metabolic syndrome. Interestingly however, we have also noted a significant contribution of active inflammatory disease and certain ethnic backgrounds are particularly prone to metabolic syndrome most notably from patients from a Korean and Hispanic background. All of this suggests that stratifying patients according to cardiovascular risk maybe possible from early on in disease and future work will focus on how changing our therapeutic regimes may impact on cardiovascular risk in lupus.

The management of cardiovascular risk should therefore be multifactorial and multidisciplinary. Close attention to traditional risk factors and the metabolic syndrome should be a cornerstone of management. We should also aim to suppress disease as completely as possible whilst minimising the use of the dose of corticosteroid therapy and ensuring patients without contra indications are treated with anti-malarial agents. Clinical trials will be required to prove the efficacy of key therapies but such trials will require a concerted international effort.

Disclosure of Interest I. Bruce Grant/research support from: Genzyme, Roche, UCB, Pfizer, Consultant for: UCB, Roche, GSK, Medimmune, Pfizer, Speakers bureau: UCB, Roche, GSK, Medimmune, Pfizer