Inflammatory rheumatic disease and smoking are predictors of aortic inflammation: A controlled study of biopsy specimens obtained at coronary artery surgery

Abstract

Objective. Several inflammatory rheumatic diseases are associated with accelerated atherosclerosis. Atherosclerosis may result from systemic and/or local vascular inflammation. The aim of this study was to evaluate the occurrence of chronic inflammatory infiltrates in the aortas of patients with and those without inflammatory rheumatic disease who had undergone coronary artery bypass graft (CABG) surgery, and to assess the relationship between the infiltrates and other factors thought to play a role in atherosclerosis, such as smoking.Methods. Aortic specimens routinely removed during CABG surgery in 66 consecutive patients with inflammatory rheumatic disease and 51 control patients without inflammatory rheumatic disease were examined by light microscopy for the occurrence, location, and severity of chronic inflammatory infiltrates and atherosclerotic lesions.Results. Mononuclear cell infiltrates in the inner adventitia (apart from those localized along the epicardium) were more frequent in the group of patients with inflammatory rheumatic disease (47% versus 20%; P ‫؍‬ 0.002, odds ratio [OR] OR 3.6, 95% confidence interval [95% CI] 1.6-8.5), and the extent of these infiltrates was greater. Multivariate analyses revealed that the occurrence of mononuclear cell infiltrates was associated with inflammatory rheumatic disease (OR 2.99, P ‫؍‬ 0.020) and current smoking (OR 3.93, P ‫؍‬ 0.012), and they were observed in 6 of 7 patients with a history of aortic aneurysm. Inflammatory infiltrates in the media were seen only in patients with inflammatory rheumatic disease. The frequency of atherosclerotic lesions, inflammation within the plaques, and epicardial inflammatory infiltrates in the 2 groups was equal.Conclusion. Among aortic samples collected during CABG surgery, those obtained from patients with inflammatory rheumatic disease had more pronounced chronic inflammatory infiltration in the media and inner adventitia than those obtained from control patients. Current smoking was an independent predictor of chronic inner adventitial infiltrates. The infiltrates may represent an inflammatory process that promotes atherosclerosis and formation of aneurysms.Several inflammatory rheumatic diseases, such as rheumatoid arthritis (RA) and systemic lupus erythem-

Brief Report: Proatherogenic Cytokine Microenvironment in the Aortic Adventitia of Patients With Rheumatoid Arthritis

“…The biopsy specimens were fixed in formalin, embedded in paraffin, and cut in 3‐μm–thick sections. Some findings regarding the aortic adventitia and internal thoracic artery used in this study have been reported previously 6, 9.…”

Inflammatory Cell Infiltrates in Vessels With Different Susceptibility to Atherosclerosis in Rheumatic and Non-Rheumatic Patients A Controlled Study of Biopsy Specimens Obtained at Coronary Artery Surgery

“…Giant cells were present in the aorta only, in a single patient with psoriatic arthritis. 3 The occurrence of MCIs in the SV was not statistically significantly associated with age, gender, presence of vascular calcification, smoking, body mass index, diabetes mellitus, hypertension, hypercholesterolemia, family history of coronary artery disease, acute coronary syndrome, duration of coronary artery disease, C-reactive protein, erythrocyte sedimentation rate, current use of oral glucocorticosteroids, disease-modifying drugs, nonsteroidal anti-inflammatory drugs, or statins. The occurrence of MCIs in the IMA was too low to look for such relationships.…”

“…Most of the aortic findings were published previously. 3 Preoperative physical findings, medical history, treatment, and previous and current smoking of cigarettes (yes/no) were recorded, and blood tests were performed. The surgeons noted gross signs of pathology in the SV and IMA vessel walls and the quality of the venous conduit (good, medium, or poor).…”

“…3 The occurrence of MCIs in the media or adventitia of the vessels is shown in Table 2. MCIs were present in the SV in 18 of 106 subjects (17%), in the IMA in 2 of 96 (2%), and in the aorta in 40 of 115 subjects (35%).…”

“…3,[12][13][14][15][16][17] Surgical IMA or SV specimens were obtained from 65 of the 70 patients with IRD (IRD group) and 51 of the 53 patients without IRD (controls). SV specimens were available from 61 IRD patients and 45 controls, for a total of 106 patients.…”