Cardiovascular Consequences of Autoimmune Rheumatic Diseases

Abstract

: The increased risk of cardiovascular disease (CVD) among patients with autoimmune rheumatic dis-eases such as rheumatoid arthritis, spondyloarthritis and systemic lupus erythematosus has been exten-sively documented. Sub-clinical atherosclerosis can be assessed using various non-invasive imaging techniques. However, the mechanisms underlying the greater risk of atherosclerotic CVD in patients with autoimmune rheumatic diseases are not fully known, although they seem to include chronic low-grade systemic inflammation leading to prolonged endothelial activation, accompanied by a pro-thrombotic/pro-coagulant and autoantibody state. Furthermore, sub-clinical atherosclerosis is also in-fluenced by other traditional risk factors for CVD. Including the individual components of the meta-bolic syndrome (MetS: obesity, impaired glucose metabolism, dyslipidemia and high blood pressure), the degree of which is higher in these patients than in controls. The aim of this narrative review is to discuss the CV manifestations and risk factors involved in the increased risk of CVD among patients with autoimmune rheumatic diseases.

Monocyte-to-high-density lipoprotein ratio as a predictor for patients with Takayasu arteritis and coronary involvement: a double-center, observational study

“…However, the mechanism underlying cardiovascular events relevant to autoimmune diseases has not been completely elucidated. It seems to occur as a result of the accelerated atherosclerosis caused by prolonged endothelial activation in a proinflammatory environment and a prothrombotic and procoagulant state, combined with traditional cardiovascular risk factors ( 21 , 22 ). In fact, as a well-established traditional cardiovascular risk factor, dyslipidemia can accelerate both inflammation and atherosclerosis in these conditions, while oxidized low-density lipoprotein is now recognized as a bridge between autoimmunity and atherosclerosis ( 23 , 24 ).…”

Cardiovascular Risk Prediction Parameters for Better Management in Rheumatic Diseases

“…Autoimmune-inflammatory rheumatic disorders, particularly ankylosing spondylitis (AS), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), and rheumatoid arthritis (RA), have been associated with early accelerated atherosclerosis (ATS) [ 8 ]. Cardiac autonomic neuropathy, arrhythmias, microvascular dysfunction, and non-ischemic heart failure are also emerging as major contributors to the broad CV involvement; especially considering that inflammatory cells have the ability to directly impact the entire CV system [ 5 , 9 ].…”

Comparison of CVD Risk Assessment via Qrisk®2 vs Reynolds Risk Score in Inflammatory Joint Diseases

“…8 Among the inflammatory joint diseases, rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus and systemic sclerosis are known to be associated with an accelerated type of atherosclerosis. 9 Major contributors to the cardiovascular disease in this patient population includes arrythmias, cardiac autonomic neuropathy, non-ischemic heart failure and microvascular dysfunction in the light of information that inflammatory cells can directly affect the whole cardiovascular system. 7,10 The increased risk of cardiovascular disease in a patient with rheumatoid arthritis results in a reduced life lifespan of anywhere between 3-18 years.…”