Table 3.

Summary of cardiovascular risk factor treatment recommendations for patients with systemic lupus erythematosus.

Risk factor	Target value	Treatment	Ref.
Hypercholesterolemia	LDL < 100 mg/dl	If LDL is 100–129 mg/dl, then institute lifestyle modifications; If LDL is 130 mg/dl or higher, then initiate a statin and discuss lifestyle modification	[56,138–142,166]
Hypertension	< 130 mmHg systolic < 80 mmHg diastolic	If BP is between 130 and 140 systolic/80–90 diastolic, can discuss lifestyle modifications If BP is 140/90 mmHg or higher, should start on ACE inhibitor (or ARB), especially in setting of SLE with renal disease, diabetes or prior CVD event; Thiazide diuretics also remain an acceptable first choice; If still uncontrolled, start a second agent	[138,146–157]
Diabetes	Hemoglobin A1C ≤ 7.0%	Annual testing of fasting glucose for diagnosis, normal is 126 mg/dl or less; Glycemic control should be managed in conjunction with primary-care physician or specialist	[56,138,189]
Smoking	Stop smoking	Work in conjunction with primary-care physician; Smoking cessation clinic if available; Nicotine replacement therapy or bupropion if over ten cigarettes per day	[183]
Obesity	BMI < 25 kg/m2	If BMI is higher than 25, consider referral to dietician; Discuss aerobic exercise plan; If possible, adjust steroid dose	[138,188]
Others: -Aspirin -Hydroxychloroquine -Corticosteroid -Hormones -Exercise	–	Unless an absolute contraindication, aspirin 81 mg daily in all patients with SLE; Unless an absolute contraindication, hydroxychloroquine daily in all SLE patients; Minimize corticosteroid use where possible; Oral contraceptives and hormone replacement only in properly selected patients and avoid in patients with antiphospholipid antibodies; Regular aerobic exercise for all SLE patients	[30,61,166,174,179–182,184–187]

ACE: Angiotensin-converting enzyme; ARB: Angiotensin receptor blocker; BP: Blood pressure; CVD: Cardiovascular disease; LDL: Low-density lipoprotein; SLE: Systemic lupus erythematosus.