Early Coronary Artery Disease in a Female Patient with Discoid Lupus Erythematosus and Hashimoto’s Thyroiditis

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Biljana Dimitrovska
Simona Jovchevska
I. Bede
Elif Vraynko
Nela Kostova
Biljana Zafirovska
Magdalena Otljanska


BACKGROUND: Atherosclerosis is a chronic inflammatory condition involving the endothelium of the blood vessels, predominant the coronary arteries. Main risk factors are dyslipidemia, hypertension, diabetes, smoking, obesity, and lack of physical activity.  Patients  with autoimmune diseases, including rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis etc., have a twofold increased risk of developing CAD at younger age, compared with the general population.

CASE REPORT: A 41-year-old female patient, with history of smoking and dyslipidemia, was admitted to our hospital with acute inferoposterior myocardial infarction. Initially, coronary reperfusion therapy per protocol was administrated and primary percutaneous coronary intervention (PCI) was performed. Multivessel CAD was found, and two stents were implanted on obtuse marginal and circumflex artery. Transthoracic echocardiography (TTE)  revealed left ventricle systolic and diastolic dysfunction with segmental hypokinesis. Additionally, the patient was first diagnosed with DLE at the age of  15, but the disease was uncontrolled in the last 7 years. She also has hypothyroidism, regularly treated with hormone replacement therapy. The  patient was discharged with medicamentous therapy including dual antiplatelet agents, statin, beta-blocker, angiotensin-receptor blocker, potassium sparing diuretic and proton pump inhibitor. One month later, recoronarography was performed with stenting of left anterior descending artery. TTE showed improvement of the left ventricle systolic function with preserved ejection fraction. The blood test showed elevated levels of antithyroid antibodies. A rheumatologist was consulted, who recommended therapy with hydroxychloroquine and regular follow-ups.

CONCLUSION: In younger patients with chronic inflammatory diseases, inflammatory mediators play a significant role in the development of the  atherosclerotic plaques, regardless of co-existing risk factors. Therefore, an early cardiovascular assessment is required in these patients for preventing severe or life-threatening cardiovascular events.


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Dimitrovska B, Jovchevska S, Bede I, Vraynko E, Kostova N, Zafirovska B, Otljanska M. Early Coronary Artery Disease in a Female Patient with Discoid Lupus Erythematosus and Hashimoto’s Thyroiditis. SEE J Cardiol [Internet]. 2023 Aug. 15 [cited 2024 Apr. 23];4(1):47-51. Available from: https://seejca.eu/index.php/seejca/article/view/6048
General Cardiology


Zeller CB, Appenzeller S. Cardiovascular disease in systemic lupus erythematosus: The role of traditional and lupus related risk factors. Curr Cardiol Rev. 2008;4(2):116-22. https://doi.org/10.2174/157340308784245775 PMid:19936286

Jha SB, Rivera AP, Monar GV, Islam H, Puttagunta SM, Islam R. Systemic lupus erythematosus and cardiovascular disease. Cureus. 2022;14(2):e22027. https://doi.org/10.7759/cureus.22027 PMid:35282557

Schoenfeld SR, Kasturi S, Costenbader KH. The epidemiology of atherosclerotic cardiovascular disease among patients with SLE: A systematic review. Semin Arthritis Rheum. 2013;43(1):77-95. https://doi.org/10.1016/j.semarthrit.2012.12.002 PMid:23422269

McDaniel B, Sukumaran S, Koritala T, Tanner LS. Discoid lupus erythematosus. In: StatPearls. Treasure Island, FL: StatPearls Publishing; 2022. Available from: https://www.ncbi.nlm.nih.gov/ books/NBK493145 [Last accessed on 2023 Jan 15].

Kammari CB, Daggubati SR, Konala VM, Adapa S, Naramala S. Association of autoimmune hashimoto’s thyroiditis with systemic lupus erythematosis. Cureus. 2020;12(3):e7261. https://doi.org/10.7759/cureus.7261 PMid:32292673

Akarsu S, Ozbagcivan O, Semiz F, Aktan S. High prevalence of metabolic syndrome in patients with discoid lupus erythematosus: A cross-sectional, case-control study. J Immunol Res. 2017;2017:3972706. https://doi.org/10.1155/2017/3972706 PMid:28127570

Hesselvig JH, Ahlehoff O, Dreyer L, Gislason G, Kofoed K. Cutaneous lupus erythematosus and systemic lupus erythematosus are associated with clinically significant cardiovascular risk: A Danish nationwide cohort study. Lupus. 2017;26(1):48-53. https://doi.org/10.1177/0961203316651739 PMid:27235406

Manzi S, Meilahn EN, Rairie JE, Conte CG, Medsger TA Jr., Jansen-McWilliams L, et al. Age-specific incidence rates of myocardial infarction and angina in women with systemic lupus erythematosus: Comparison with the Framingham study. Am J Epidemiol. 1997;145(5):408-15. https://doi.org/10.1093/oxfordjournals.aje.a009122 PMid:9048514

Tselios K, Gladman DD, Su J, Ace O, Urowitz MB. Evolution of risk factors for atherosclerotic cardiovascular events in systemic lupus erythematosus: A longterm prospective study. J Rheumatol. 2017;44(12):1841-9. https://doi.org/10.3899/jrheum.161121 PMid:29093154

Esdaile JM, Abrahamowicz M, Grodzicky T, Li Y, Panaritis C, du Berger R, et al. Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus. Arthritis Rheum. 2001;44(10):2331-7. https://doi.org/10.1002/1529-0131(200110)44:10<2331:aid- art395>3.0.co;2-I PMid:11665973

Lin CY, Shih CC, Yeh CC, Chou WH, Chen TL, Liao CC. Increased risk of acute myocardial infarction and mortality in patients with systemic lupus erythematosus: Two nationwide retrospective cohort studies. Int J Cardiol. 2014;176(3):847-51. https://doi.org/10.1016/j.ijcard.2014.08.006 PMid:25156834

Posselt RT, Coelho VN, Pigozzo DC, Guerrer MI, Fagundes MD, Nisihara R, et al. Prevalence of thyroid autoantibodies in patients with systematic autoimmune rheumatic diseases. Cross-sectional study. Sao Paulo Med J. 2017;135(6):535-40. https://doi.org/10.1590/1516-3180.2017.008911061 PMid:29267515

Sara JD, Zhang M, Gharib H, Lerman LO, Lerman A. Hypothyroidism is associated with coronary endothelial dysfunction in women. J Am Heart Assoc. 2015;4(8):e002225. https://doi.org/10.1161/JAHA.115.002225 PMid:26224049

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