Vascular imaging: changing the face of cardiovascular research

Patients with systemic lupus erythematosus (SLE) are at significant risk fo r premature-cardiovascular disease, now a leading cause of death in this po pulation. Most previous studies have used an overt clinical event to identi fy cardiovascular disease, likely underestimating the actual prevalence in these patients. Although the rates of myocardial infarction in SLE are high , the actual number of coronary events is low, precluding large clinical tr ials using a coronary event as the sole outcome. The ability to measure ath erosclerosis, a known determinant of coronary heart disease, provides inves tigators with a desirable surrogate for the clinical cardiac event. With th e advent of sensitive imaging techniques to identify subclinical atheroscle rosis, we are now better equipped to determine the true prevalence and mech anisms of vascular disease in SLE. In this review, we will discuss several vascular imaging techniques and the current trend away from measuring flow- limiting vessel stenosis toward measuring earlier structural and functional aspects of the vascular system.