Accelerated Atherosclerosis in Autoimmune Rheumatic Diseases

Shoenfeld, Yehuda; Gerli, Roberto; Doria, Andrea; Matsuura, Eiji; Cerinic, Marco Matucci; Ronda, Nicoletta; Jara, Luis J.; Abu-Shakra, Mahmoud; Meroni, Pier Luigi; Sherer, Yaniv

doi:10.1161/circulationaha.104.507996

Cited by 504 publications

(476 citation statements)

References 90 publications

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“…An increased risk of cardiovascular disease (CVD) in patients with rheumatic diseases including inflammatory arthritis (IA) and systemic lupus erythematosus (SLE) is well recognized [1][2][3]. While IA patients are treated with disease modifying anti-rheumatic drugs (DMARDs) and biologic agents that reduce disease activity, multiple studies have demonstrated increased cardiovascular (CV) risk despite conventional anti-rheumatic therapy [4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Lack of cardiovascular risk assessment in inflammatory arthritis and systemic lupus erythematosus patients at a tertiary care center

2011

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The purpose of this study is to evaluate cardiovascular risk assessment at a Canadian rheumatology center and describe the cardiovascular risk of inflammatory arthritis (IA) and systemic lupus erythematosus (SLE) patients using the Framingham risk score. A retrospective chart review of 504 patients attending nine rheumatology practices at the University of Alberta Hospital was performed. A pre-specified case report form detailed patient demographics, cardiac risk factors, variables for the Framingham 2008 score, disease activity, and medication use. In this group of 504 patients, 64 (12.7%) had SLE (male (M) to female (F) ratio=60:4) and 440 (87.3%) had an IA (M to F ratio=117:323). Of the SLE patients, 31 (48.4%) met four or more American College of Rheumatology (ACR) criteria, 33 (51.6%) had less than four ACR criteria. Of the IA patients, 156 (35.5%) were CCP positive and 257 (58.4%) were RF positive. Utilizing the chart data, retrospective Framingham risk scores were calculable for one (1.6%) SLE patient and three (0.68%) IA patients. The most common cardiac risk factors not documented in the medical records of both the SLE and IA patients included: (1) positive family history of MI, (2) diabetes, and (3) lipid status. The blood pressure was more frequently documented in the SLE patients (93.8%) compared to the IA patients (56.1%). While traditional cardiac risk factors only partially contribute to the increased cardiovascular risk in these patients, cardiovascular risk assessment was suboptimally performed amongst a large group of rheumatologists. A dedicated cardiovascular risk reduction clinic for inflammatory rheumatic diseases has been established at this site to fulfill this need and evaluate treatment strategies.

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Section: Introductionmentioning

confidence: 99%

Lack of cardiovascular risk assessment in inflammatory arthritis and systemic lupus erythematosus patients at a tertiary care center

2011

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“…Over the past decade, it has become evident that upregulation of inflammation and autoimmune aggression in certain systemic disorders such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) may substantially accelerate atherogenesis and increase the risk of vascular events [10][11][12]. Basic and clinical research studies in this *Address correspondence to this author at the Boğaziçi University, Department of Molecular Biology and Genetics, 34342 Bebek/Istanbul, Turkey; Tel: +90(212) 359-77-84; Fax: +90 (212) 287-2468; E-mail: sahru.yuksel@boun.edu.tr field have led to the emergence of a new biomedical discipline, vascular rheumatology [13], which aims to clarify pathophysiology of rheumatic diseases and co-morbidities and to propose recommendations for primary and secondary prevention of vascular events in the general population.…”

Section: Introductionmentioning

confidence: 99%

Familial Mediterranean Fever as an Emerging Clinical Model of Atherogenesis Associated with Low-Grade Inflammation

Yüksel¹,

Ayvazyan²,

Gasparyan³

2010

TOCMJ

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Numerous inflammatory and innate immune pathways are involved in atherogenesis. Elaboration of clinical models of inflammation-induced atherogenesis may further advance our knowledge of multiple inflammatory pathways implicated in atherogenesis and provide a useful tool for cardiovascular prevention. Familial Mediterranean fever (FMF) is a chronic inflammatory disorder with profiles of inflammatory markers close to that seen in the general population. In a few recent studies, it has been shown that endothelial dysfunction, increased atherosclerotic burden and activation of platelets accompany attack-free periods of FMF. Colchicine is proved to be useful in suppression of inflammation in FMF. Preliminary basic and clinical studies suggest that this relatively safe drug may be useful for cardiovascular protection in patients with FMF and in the general population. Multinational prospective studies are warranted to further elaborate clinical model of inflammation-induced atherosclerosis associated with FMF.

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“…Premature atherosclerosis has been observed during the course of different systemic inflammatory diseases, such as rheumatoid arthritis and systemic lupus erythematosus [7][8][9][10][11][12][13][14][15][16][17][18]. In these diseases, an increased prevalence of atherosclerosis and, consequently, increased cardiovascular morbidity and mortality has been observed.…”

Section: Introductionmentioning

confidence: 99%

Translational Mini-Review Series on Immunology of Vascular Disease: Accelerated atherosclerosis in vasculitis

Tervaert

2009

Clinical and Experimental Immunology

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SummaryPremature atherosclerosis has been observed during the course of different systemic inflammatory diseases such as rheumatoid arthritis and sytemic lupus erythematosus. Remarkably, relatively few studies have been published on the occurrence of accelerated atherosclerosis in patients with vasculitis. In giant cell arteritis (GCA), mortality because of ischaemic heart disease is not increased. In addition, intima media thickness (IMT) is lower in patients with GCA than in age-matched controls. In contrast, IMT is increased significantly in Takayasu arteritis, another form of large vessel vasculitis occurring in younger patients. In Takayasu arteritis and in Kawasaki disease, a form of medium-sized vessel vasculitis, accelerated atherosclerosis has been well documented. In small vessel vasculitis because of anti-neutrophil cytoplasmic autoantibodies-associated vasculitis, cardiovascular diseases are a major cause of mortality. IMT measurements reveal conflicting results. During active disease these patients experience acceleration of the atherosclerotic process. However, when inflammation is controlled, these patients have atherosclerotic development as in healthy subjects. Several risk factors, such as diabetes and hypertension, are present more often in patients with vasculitis compared with healthy controls. In addition, steroids may be pro-atherogenic. Most importantly, many patients have impaired renal function, persistent proteinuria and increased levels of C-reactive protein, well-known risk factors for acceleration of atherosclerosis. Enhanced oxidation processes, persistently activated T cells and reduced numbers of regulatory T cells are among the many pathophysiological factors that play a role during acceleration of atherogenesis. Finally, autoantibodies that may be relevant for acceleration of atherosclerosis are found frequently in elevated titres in patients with vasculitis. Because patients have an increased risk for cardiovascular events, vasculitis should be treated with as much care as possible. In addition, treatment should be considered with angiotensin-converting-enzyme inhibitors and/or angiotensin receptor-1 blockers, statins and acetylsalicyl acid. Finally, classical risk factors for cardiovascular disease should be monitored and treated as much as possible.

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Accelerated Atherosclerosis in Autoimmune Rheumatic Diseases

Cited by 504 publications

References 90 publications

Lack of cardiovascular risk assessment in inflammatory arthritis and systemic lupus erythematosus patients at a tertiary care center

Lack of cardiovascular risk assessment in inflammatory arthritis and systemic lupus erythematosus patients at a tertiary care center

Familial Mediterranean Fever as an Emerging Clinical Model of Atherogenesis Associated with Low-Grade Inflammation

Translational Mini-Review Series on Immunology of Vascular Disease: Accelerated atherosclerosis in vasculitis

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