Introduction
Systemic Lupus Erythematosus (SLE) is a serious and potentially fatal autoimmune disease that affects multiple organ systems and is frequently disabling. African Americans experience SLE at a higher incidence of almost three times that of other ethnicities. Additionally, African Americans develop SLE earlier in life and suffer increased mortality and morbidity when compared to other ethnicities (Drenkard et al., 2019). Furthermore, premature atherosclerosis is the leading cause of death among patients diagnosed with SLE. African Americans with SLE experience severe heart disease compared to white Americans (Hammand, 2019). Although, screening and management of CVD risk factors and coronary disease risk monitoring is essential and is an important aspect of the Clinical Practice guidelines for SLE, it is currently an unmet need by clinicians (Tamirou et al., 2019).

Literature Review
Lupus and CVD is increasingly becoming a significant health problem in modern medicine. According to the literature, minorities, premenopausal women and patients with SLE between the ages of 20-39 are increasingly at risk of death from accelerated atherosclerotic particularly during the first year after diagnosis as well as 2 years preceding diagnosis (Tselios et al., 2016). In a systematic review by Tselios, et al (2016) minimum investigations to optimally monitoring CVD risk in SLE were identified. Ponticelli & Moroni (2017) conducted a multivariate regression study to estimate incremental healthcare utilization and SLE costs. They established that the incremental expense related to SLE per year was $10,984. The study concluded that patients with SLE had higher healthcare costs and resource utilization than non-SLE patients. Lupus Foundation of America records that at least 1.5 million people in America are living with diagnosed Lupus while many lupus cases go untreated and undiagnosed (Song et al., 2018).
Song et al. (2018) conducted a qualitative study to establish the mortality rate in SLE and showed that despite the advanced treatment, the standardized mortality rate in SLE is three times higher than in the general population. The study found that the risk of mortality is usually high for SLE because of renal and cardiovascular diseases. Additionally, based on a qualative research study conducted by Lam et al. (2016), SLE is a significant risk factor for CVD in addition to traditional risk factors such as hyperlipidemia and smoking (Croca, 2012). On the contrary, delayed or late diagnosis, poor adherence to therapeutic regimens, poor access to care, and less effective treatment would increase the disease’s effects, increasing complications and death risks (Lam et al., 2016; Song et al. 2018). Various interventions to include early diagnosis and screening, followed by effective treatment, will reduce the SLE damaging effects from CVD and enhance the chance to have improved quality of life.

Conclusion
Conclusively, scientists have continued to caution about this disease’s seriousness, mainly because its cure is yet to be established. Early identification of SLE and CVD risk factors commonly seen in lupus patients is imperative to reducing the morbidity and mortality rate, cost of treatment and length of hospital stay in this population. Research supports that ineffective patient-clinician communication along with lack of CVD screening presents a major obstacle to reducing modifiable risk factors for CVD in SLE and accounts for the health disparity among the African American population.

References
Islam, M. A., Khandker, S. S., Alam, S. S., Kotyla, P., & Hassan, R. (2019). Vitamin D status in patients with systemic lupus erythematosus (SLE): A systematic review and meta-analysis. Autoimmunity Reviews, 18(11), 102392.
https://doi.org/10.1016/j.autrev.2019.102392
Ponticelli, C., & Moroni, G. (2017). Hydroxychloroquine in systemic lupus erythematosus (SLE). Expert opinion on drug safety, 16(3), 411-419. https://doi.org/10.1080/14740338.2017.1269168
Song, L., Wang, Y., Zhang, J., Song, N., Xu, X., & Lu, Y. (2018). The risks of cancer development in systemic lupus erythematosus (SLE) patients: a systematic review and meta-analysis. Arthritis research & therapy, 20(1), 270. https://doi.org/10.1186/s13075-018-1760-3