All major organs may be impacted by the connective disease systemic lupus erythematosus, a separate risk factor for coronary artery disease (CAD). Adhesion molecules like intercellular adhesion molecules (ICAM) and vascular cell adhesion molecules (VCAM) can detect endothelial damage and dysfunction, which appear to play a crucial role. This study investigated whether people with SLE had elevated subclinical and clinical atherosclerosis risk factors. Traditional CAD risk factors such as smoking, hypertension, and hyperlipidemia cannot entirely explain this elevation. It is thought that immunological dysfunction also increases CAD risk in SLE patients. The study aimed to assess early endothelial changes in SLE Iraqi female patients without previous coronary artery lesions by exploring a potential relationship between circulating VCAM-1 and ICAM-1 as risk factors for atherosclerosis and the relationship of CAD with SLE disease and its severity; further, the study explained the effect of the hydroxychloroquine (HCQ) on the lipid profile levels of the patients. 92 female SLE patients were divided into mild, moderate, and severe, according to the SLE disease activity index 2000 (SLEDAI-2k), compared with 30 apparently healthy control individuals. All of them need a history of CAD. Serum VCAM-1, ICAM-1 level, VCAM-1/ICAM1 ratio, TC, HDL, LDL levels TC/HDL and LDL/HDL ratios were measured. sVCAM-1, sICAM-1 levels and VCAM-1/ICAM-1 ratio were significantly and gradually increased in patient groups compared with control. Serum TC, HDL and LDL levels were significantly reduced in the SLE patients compared to the control. At the same time, the TC/HDL and LDL/HDL ratios were significantly elevated with the severity of the SLE disease. sVCAM-1, sICAM-1 level and VCAM1/ICAM-1 ratio together with serum TC/HDL and LDL/HDL may improve coronary artery disease risk categorization in SLE patients without acute coronary syndromes. Furthermore, they were more sensitive in severe SLE instances than in moderate and mild ones, suggesting that they may be related to the extent of coronary lesions in SLE patients. VCAM-1 had a higher sensitivity than ICAM-1 in detecting and severity screening for CAD in SLE patients. Keywords: VCAM-1, ICAM-1, SLE, Atherosclerosis
