Cardiorheumatology: cardiac involvement in systemic rheumatic disease

Abstract

Autoimmune rheumatic diseases can affect the cardiac vasculature, valves, myocardium, pericardium, and conduction system, leading to a plethora of cardiovascular manifestations that can remain clinically silent or lead to substantial cardiovascular morbidity and mortality. Although the high risk of cardiovascular pathology in patients with autoimmune inflammatory rheumatological diseases is not owing to atherosclerosis alone, this particular condition contributes substantially to cardiovascular morbidity and mortality—the degree of coronary atherosclerosis observed in patients with rheumatic diseases can be as accelerated, diffuse, and extensive as in patients with diabetes mellitus. The high risk of atherosclerosis is not solely attributable to traditional cardiovascular risk factors: dysfunctional immune responses, a hallmark of patients with rheumatic disorders, are thought to cause chronic tissue-destructive inflammation. Prompt recognition of cardiovascular abnormalities is needed for timely and appropriate management, and aggressive control of traditional risk factors remains imperative in patients with rheumatic diseases. Moreover, therapies directed towards inflammatory process are crucial to reduce cardiovascular disease morbidity and mortality. In this Review, we examine the multiple cardiovascular manifestations in patients with rheumatological disorders, their underlying pathophysiology, and available management strategies, with particular emphasis on the vascular aspects of the emerging field of ‘cardiorheumatology’.

Acute Respiratory Events in Connective Tissue Disorders

“…Increased recognition of acute heart-related respiratory events leads to appropriate management and prevention. Appropriate management of the underlying disease with optimal control of CTD activity, specific cardiovascular treatment, and prevention of traditional risk factors may decrease the prevalence of acute heart-related respiratory events, and most importantly the associated morbidity and mortality, in CTD patients [192,193,205,206,207]. …”

Cardiovascular events in patients with systemic lupus erythematosus and their association with cardiovascular risk factors

“…Aunque los riesgos tradicionales como la dislipidemia y el tabaquismo han sido demostrados como factores predictores de riesgo cardiovascular en pacientes con LES, el lupus en sí mismo es un factor de riesgo independiente para enfermedad cardiovascular [7,14,23]. Varios tipos de enfermedad cardiovascular fueron observados entre los pacientes con LES, incluyendo pericarditis, miocarditis, enfermedad del sistema de conducción, vasculitis, enfermedad valvular, así como también enfermedad coronaria, enfermedad cerebrovascular, insuficiencia cardiaca congestiva y enfermedad arterial periférica [11].…”

“…En relación al síndrome antifosfolipídico, este síndrome está caracterizado por un riesgo incrementado para accidentes cerebrovasculares e infartos de miocardio y por lo tanto, varios estudios han intentado determinar si la presencia de anticuerpos antifosfolipídicos puede ser un factor de riesgo independiente para enfermedad cardiovascular [11]. En el estudio LUMINA [24] la presencia de anticuerpos antifosfolipídicos estuvo significativamente asociada a un incremento del riesgo 4 veces mayor de tener un evento cardiovascular en un promedio de tiempo de aproximadamente 6 años.…”

“…En este sentido, publicaciones previas han demostrado que la presencia de los factores de riesgo cardiovascular (FRCV) tradicionales por si solos no explican la frecuencia de eventos cardiovasculares en este grupo de pacientes. Actualmente, se considera que el elevado riesgo cardiovascular se debe no solo a estos FRCV, sino también a factores asociados con la enfermedad, como el proceso inflamatorio crónico, la presencia del síndrome antifosfolípidico (SAF), el compromiso renal y el tratamiento farmacológico concomitante, entre otros [8,[11][12][13][14].…”

Cardiovascular risk and inflammation in rheumatic diseases

“…Cardiovascular manifestations of rheumatic diseases have been thoroughly examined over the past decades. It has been established that all structures of the heart can be affected due to the long-term systemic inflammation and specific autoimmune and autoinflammatory factors [1]. Classic clinical models of cardiovascular phenomenon in rheumatic diseases are rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), which are associated with enhanced course of atherosclerosis and various atherothrombotic events.…”