Accelerated atherosclerosis in patients with Wegener's granulomatosis

Leeuw, Karina de

doi:10.1136/ard.2004.029033

Cited by 136 publications

(97 citation statements)

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“…The presence of anti-SSA/Ro antibodies and dyslipoproteinemia with low levels and dysfunction of HDL is related to AT in Sjögren's syndrome 26 . The endothelial dysfunction seen in primary vasculitis is very close to the dysfunction in atherosclerosis and this aside, dyslipoproteinemia, activation of macrophages and ANCA antibodies also play a major role 27 . This study has shown the very high prevalence of common atherosclerotic risk factors such as smoking, obesity, hypertension, diet, diabetes and sedentary life style in the studied group of lupus patients, confirming findings of other authors describing higher rates in SLE than in a general aged matched population.…”

Section: Discussionmentioning

confidence: 99%

Intima media thickness measurement as a marker of subclinical atherosclerosis in SLE patient

Smrzova¹,

Horák²,

Skácelová³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Aim. Accelerated atherosclerosis in systemic lupus erythematosus (SLE) is an important cause of morbidity and mortality. The pathophysiology of accelerated atherosclerosis in SLE is mediated by factors such as inflammatory processes in the vascular wall, specific antibodies, dyslipoproteinemia, endothelial dysfunction and the high prevalence of traditional risk factors for cardiovascular diseases. In this context, we evaluated the clinical significance of ultrasound examination of the carotic arteries in the early diagnosis of atherosclerosis. Methods. The study included 63 patients with SLE (female: male 53:10, mean age 38.4±12.7 years, mean disease duration 143.0 ±82.6 months), 24 patients had lupus nephritis. The control group consisted of 24 volunteers (female: male 20:4 mean age 31.04±8.59). Intima media thickness (IMT) was measured by ultrasound on both sides. The results were correlated with markers of lipid spectrum, anti-dsDNA, antinucleosomal and anticardiolipin antibodies, lupus anticoagulant and complement components. Clinical disease activity and damage were evaluated by SLEDAI and SLICC indices. Lifestyle and other important factors were examined per protocol and by questionnaire. Results. A significant difference of IMT (P≤0.03) was found between the lupus patients and sex-age adjusted healthy controls with an in mean IMT in SLE patients of 0.569±0.11 mm, in control group 0.495±0.05 mm. A significant correlation between IMT and disease duration, age, positivity of lupus anticoagulant, use of ACE inhibitors, glomerular filtration and serum creatinine were found. No difference in IMT was found between patients with or without lupus nephritis. Conclusion. IMT measurement could be used as a clinical predictor of risk of accelerated atherosclerosis in lupus patients.

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Section: Discussionmentioning

confidence: 99%

Intima media thickness measurement as a marker of subclinical atherosclerosis in SLE patient

Smrzova¹,

Horák²,

Skácelová³

et al. 2014

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…Zaenker et al [49] and de Leeuw et al [51] found increased IMT values in patients with ANCA-associated vasculitis compared with healthy controls, whereas no increase was observed in two other studies [52] (M. C. Slot and J. W. Cohen Tervaert, unpublished observation). Other markers for atherosclerosis have also been studied in patients with ANCA-associated vasculitis.…”

Section: Occurrence Of Accelerated Atherosclerosis In Vasculitismentioning

confidence: 93%

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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“…For example, endothelium-dependent vasodilatation of brachial arteries is impaired in patients having WG, a PSV typically involving small vessels. 76 A recent study by de Leeuw et al 77 provides the first direct evidence for enhanced atherosclerosis in PSV. In this study, common carotid artery IMT was compared between 29 patients having inactive WG and 26 control subjects.…”

Section: Apsmentioning

confidence: 97%