Cardiovascular disease in autoimmune rheumatic diseases
- PMID: 23541482
- DOI: 10.1016/j.autrev.2013.03.013
Cardiovascular disease in autoimmune rheumatic diseases
Abstract
Various autoimmune rheumatic diseases (ARDs), including rheumatoid arthritis, spondyloarthritis, vasculitis and systemic lupus erythematosus, are associated with premature atherosclerosis. However, premature atherosclerosis has not been uniformly observed in systemic sclerosis. Furthermore, although experimental models of atherosclerosis support the role of antiphospholipid antibodies in atherosclerosis, there is no clear evidence of premature atherosclerosis in antiphospholipid syndrome (APA). Ischemic events in APA are more likely to be caused by pro-thrombotic state than by enhanced atherosclerosis. Cardiovascular disease (CVD) in ARDs is caused by traditional and non-traditional risk factors. Besides other factors, inflammation and immunologic abnormalities, the quantity and quality of lipoproteins, hypertension, insulin resistance/hyperglycemia, obesity and underweight, presence of platelets bearing complement protein C4d, reduced number and function of endothelial progenitor cells, apoptosis of endothelial cells, epigenetic mechanisms, renal disease, periodontal disease, depression, hyperuricemia, hypothyroidism, sleep apnea and vitamin D deficiency may contribute to the premature CVD. Although most research has focused on systemic inflammation, vascular inflammation may play a crucial role in the premature CVD in ARDs. It may be involved in the development and destabilization of both atherosclerotic lesions and of aortic aneurysms (a known complication of ARDs). Inflammation in subintimal vascular and perivascular layers appears to frequently occur in CVD, with a higher frequency in ARD than in non-ARD patients. It is possible that this inflammation is caused by infections and/or autoimmunity, which might have consequences for treatment. Importantly, drugs targeting immunologic factors participating in the subintimal inflammation (e.g., T- and B-cells) might have a protective effect on CVD. Interestingly, vasa vasorum and cardiovascular adipose tissue may play an important role in atherogenesis. Inflammation and complement depositions in the vessel wall are likely to contribute to vascular stiffness. Based on biopsy findings, also inflammation in the myocardium and small vessels may contribute to premature CVD in ARDs (cardiac ischemia and heart failure). There is an enormous need for an improved CVD prevention in ARDs. Studies examining the effect of DMARDs/biologics on vascular inflammation and CV risk are warranted.
Keywords: Atherosclerosis; Immune system; Inflammation; Rheumatic.
Copyright © 2013 Elsevier B.V. All rights reserved.
Similar articles
-
Cardiovascular Consequences of Autoimmune Rheumatic Diseases.Curr Vasc Pharmacol. 2020;18(6):566-579. doi: 10.2174/1570161118666200127142936. Curr Vasc Pharmacol. 2020. PMID: 31985379 Review.
-
Cardio-Rheumatology: Cardiovascular Complications in Systemic Autoimmune Rheumatic Diseases / Is Inflammation the Common Link and Target?Curr Vasc Pharmacol. 2020;18(5):425-430. doi: 10.2174/1570161118666200514222236. Curr Vasc Pharmacol. 2020. PMID: 32410564
-
Perivascular adipose tissue in autoimmune rheumatic diseases.Pharmacol Res. 2022 Aug;182:106354. doi: 10.1016/j.phrs.2022.106354. Epub 2022 Jul 14. Pharmacol Res. 2022. PMID: 35842184 Free PMC article. Review.
-
Can cardiovascular magnetic resonance prompt early cardiovascular/rheumatic treatment in autoimmune rheumatic diseases? Current practice and future perspectives.Rheumatol Int. 2018 Jun;38(6):949-958. doi: 10.1007/s00296-018-4004-6. Epub 2018 Mar 7. Rheumatol Int. 2018. PMID: 29516170 Review.
-
Cardio-Rheumatology: Two Collaborating Disciplines to Deal with the Enhanced Cardiovascular Risk in Autoimmune Rheumatic Diseases.Curr Vasc Pharmacol. 2020;18(6):533-537. doi: 10.2174/1570161118666200721145718. Curr Vasc Pharmacol. 2020. PMID: 32693768
Cited by
-
Endothelial progenitor cells are differentially impaired in ANCA-associated vasculitis compared to healthy controls.Arthritis Res Ther. 2016 Jun 23;18:147. doi: 10.1186/s13075-016-1044-8. Arthritis Res Ther. 2016. PMID: 27338585 Free PMC article.
-
Validation of the adjusted global antiphospholipid syndrome score in a single centre cohort of APS patients from Turkey.J Thromb Thrombolysis. 2021 Feb;51(2):466-474. doi: 10.1007/s11239-020-02195-4. J Thromb Thrombolysis. 2021. PMID: 32588289
-
Differential Association of Psychosocial Comorbidities With Subclinical Atherosclerosis in Rheumatoid Arthritis.Arthritis Care Res (Hoboken). 2015 Oct;67(10):1335-44. doi: 10.1002/acr.22635. Arthritis Care Res (Hoboken). 2015. PMID: 26274015 Free PMC article.
-
Anti-Cyclic Citrullinated Peptide Antibody and Periodontal Status in Rheumatoid Arthritis Patients.Pak J Med Sci. 2018 Jul-Aug;34(4):907-912. doi: 10.12669/pjms.344.15007. Pak J Med Sci. 2018. PMID: 30190751 Free PMC article.
-
Vasa Vasorum Angiogenesis: Key Player in the Initiation and Progression of Atherosclerosis and Potential Target for the Treatment of Cardiovascular Disease.Front Immunol. 2018 Apr 17;9:706. doi: 10.3389/fimmu.2018.00706. eCollection 2018. Front Immunol. 2018. PMID: 29719532 Free PMC article. Review.
Publication types
MeSH terms
Grants and funding
LinkOut - more resources
Full Text Sources
Other Literature Sources
Medical