Cardiovascular complications of collagen vascular disease

Abstract

Collagen vascular diseases commonly affect the heart; cardiovascular events are the major cause of mortality in people with these diseases. A striking feature of the cardiac involvement in individuals with systemic lupus erythematosus (SLE) and rheumatoid arthritis is aggressive and accelerated atherosclerosis; women with SLE in the 35- to 44-year-old age group are more than 50 times more likely to suffer myocardial infarction than are matched controls. Traditional risk factors contribute to the accelerated atherosclerosis, but cannot explain the extent of risk. It is possible that the inflammatory process, which is similar to the inflammatory process in atherosclerosis, pays a critical pathophysiologic role. It is critically important to identify the presence of traditional cardiovascular risk factors (eg, tobacco usage, hypertension, hypercholesterolemia, diabetes, homocysteinemia), and to modify these to secondary prevention targets. Cardiac valvular disease is common in individuals with SLE and rheumatoid arthritis; its presence should be anticipated and subacute bacterial endocarditis prophylaxis precautions initiated. Cardiac autonomic neuropathy and conduction disturbances are common in people with heart disease related to systemic sclerosis and human leukocyte antigen B27; these patients should be monitored carefully for evidence of dysrhythmias.

Cardiac involvement in Crohn’s disease: Echocardiographic study

“…Among the present patients, the high majority of atrio‐ventricular valve alterations and pericardial effusions is similar, with regard to frequency and type of alteration, to what has been observed in collagenosis and connective tissue diseases such as systemic sclerosis, systemic lupus erythematosus, rheumatoid arthritis, and ankylosing spondylitis, diseases related to immune system disorder 55–57 …”

Systemic lupus erythematosus in a multiethnic US cohort (LUMINA): XXI. Disease activity, damage accrual, and vascular events in pre‐ and postmenopausal women

“…Finally, given that age is a known risk factor for the occurrence of vascular events in the general population, and in SLE patients in particular (43, 44), we wanted to determine if menopausal status, as a hypoestrogenemic state, would be the underlying factor supporting the role of age in the occurrence of vascular events. In fact, that was not the case; age, but not menopausal status, was an independent predictor of vascular arterial events.…”

Renal transplantation in lupus nephritis

“…1 In addition to the risk factors usually present in lupus nephritis (such as arterial hypertension, hyperlipemia, hypoalbuminemia, hypercoagulability), SLE patients often suffer from cardiac valvular disease 1 and may be carriers of antiphospholipid antibodies which increase the risk of cardiac and cerebral complications. 2 It is also likely that inflammation processes 3 and other disease-related factors 4 strongly contribute to the increased risk of accelerated atherosclerosis in SLE patients. Pretransplant and post-transplant corticosteroid therapy may further exacerbate cardiovascular complications, as well as produce severe osteoporosis, diabetes mellitus, myopathy, and cataracts.…”