In addition, CD4 + CD28− T cells promote inflammation by producing high levels of inflammatory cytokines including tumor necrosis factor-α (TNF-α) and interferon-γ (IFN-γ), and releasing cytotoxic molecules including perforin and granzyme B which could damage the vascular wall in patients with acute coronary syndrome, which may provide an association between the high prevalence of CVD and SLE [15]. Here, TNF is linked to systemic lupus erythematosus.