SLE Cardiovascular Risk — SCE Rheumatology MCQ

Correct answer: C — Assess traditional and disease-related risk factors, consider a blood-pressure target below 130/80 mmHg, manage lipids according to general-population guidance, maintain low disease activity, minimise glucocorticoids, continue hydroxychloroquine unless contraindicated, and use aspirin selectively for antiphospholipid-antibody risk.

Option C is correct. Cardiovascular prevention in SLE requires assessment of both conventional risk factors and disease-related contributors. EULAR advises considering a blood-pressure target below 130/80 mmHg, while lipid-lowering treatment follows general-population guidance. Low lupus activity should be maintained, glucocorticoid exposure minimised, and hydroxychloroquine used unless contraindicated; no alternative immunosuppressant is specifically recommended solely to reduce cardiovascular events. Aspirin is not routine for every patient with SLE or every positive aPL result. In a patient without previous thrombosis or pregnancy morbidity, low-dose aspirin is recommended for a high-risk aPL profile and may be considered individually for a low-risk profile. The other options either omit disease-related risk, delay appropriate screening, use an unvalidated lupus-specific calculator, or recommend indiscriminate aspirin or statin treatment.

Reference: Drosos GC et al. EULAR recommendations for cardiovascular risk management in rheumatic and musculoskeletal diseases, including systemic lupus erythematosus and antiphospholipid syndrome. Annals of the Rheumatic Diseases. 2022;81:768–779. https://pubmed.ncbi.nlm.nih.gov/35110331/