Challenges in Implementing Cardiovascular Risk Scores for Assessment of Young People With Childhood-Onset Autoimmune Rheumatic Conditions

Abstract

Cardio-vascular risk (CVR) stratification tools have been implemented in clinical practice to guide management decision for primary prevention of cardiovascular disease. Less is known about how we can optimally estimate the CVR in children and adolescents or about the reliability of the risk stratification tools validated in adult populations. Chronic inflammation associated with autoimmune rheumatic disease (ARD) drives an increased risk for accelerated atherosclerosis in patients of all ages. Although the research is less advanced than in adult populations, it is recognized that young people with ARDs with childhood-onset have increased CVR compared to age-matched healthy controls, as supported by studies investigating lipid biomarker profile and markers of endothelial dysfunction. Further research is needed to address the unmet need for adequate CVR identification and management strategies in young people in general, and in those with underlying chronic inflammation in particular. This perspective paper explores various challenges in adequately identifying and managing CVR in younger populations and potential directions for future research.

AIM2 inflammasome regulated by the IFN‐γ/JAK2/STAT1 pathway promotes activation and pyroptosis of monocytes in Coronary Artery Disease

“…More and more experimental and clinical evidence suggest a chronic inflammation was participated in AS diseases, in which immune cells and various inflammatory factors play an important role. 25,26 Our study found that the high expression of AIM2 was an independent risk factor for CAD, that could promote inflammatory responses and pyroptosis in monocyte, which might be regulated by the IFN-γ/JAK2/STAT1 pathway. 12 Researchers first observed a significant increase of AIM2 in the necrotic core of AS plaques in 2014.…”

Atherosclerosis Progression in the APPLE Trial Can Be Predicted in Young People With Juvenile‐Onset Systemic Lupus Erythematosus Using a Novel Lipid Metabolomic Signature

“…7 However, despite strong evidence of increased CVD risk in patients with JSLE, comorbidity-tailored recommendations or research directed toward stratifying and managing patients with JSLE based on CVD risk are limited. 8,9 Notably, a growing body of evidence, including data generated by our group, support that circulating biomarkers can predict CVD risk in healthy CYP 10,11 and CYP with JSLE. 12,13 Carotid intima-media thickness (CIMT) is a measure of atherosclerosis that can be used to predict CVD-related events from childhood into middle age 14 and improve the performance of traditional risk factors used for CVD risk classification.…”

“…A retrospective analysis of the large UK JSLE cohort (n = 413) identified 12 CVD‐related events, which occurred at a median age of 16 years and a median disease duration of only 2 years 7 . However, despite strong evidence of increased CVD risk in patients with JSLE, comorbidity‐tailored recommendations or research directed toward stratifying and managing patients with JSLE based on CVD risk are limited 8,9 . Notably, a growing body of evidence, including data generated by our group, support that circulating biomarkers can predict CVD risk in healthy CYP 10,11 and CYP with JSLE 12,13 …”

Impact of puberty, sex determinants and chronic inflammation on cardiovascular risk in young people

“…Assessment of disease activity in young people with chronic inflammation usually pertain to composite scores aiming to combine objective and subjective assessment of disease manifestations, as well as laboratory parameters which are relevant for systemic inflammation or immune system abnormalities contributing to chronic inflammation ( 151 – 153 ). Despite improvement in quantifying inflammation and improved guidelines to ensure tighter control of disease activity in young people with chronic inflammatory and autoimmune conditions ( 154 – 156 ), there is still evidence of increased CVD-risk in children and young people which is not adequately captured by the CVD-risk assessment tools routinely used for primary care prevention strategies in general population( 157 , 158 ).…”