Arterial Stiffness as a Surrogate Marker of Cardiovascular Disease and Atherosclerosis in Patients with Arthritides and Connective Tissue Diseases: A Literature Review

Abstract

The increased cardiovascular (CV) risk among patients with autoimmune rheumatic diseases, such as arthritides and connective tissue diseases, has been extensively documented. From a pathophysiological standpoint, systemic inflammation in the context of the disease can lead to endothelial dysfunction, accelerated atherosclerosis, and structural changes in vessel walls, which, in turn, are associated with exaggerated CV morbidity and mortality. In addition to these abnormalities, the increased prevalence of traditional CV risk factors, such as obesity, dyslipidemia, arterial hypertension, and impaired glucose metabolism, can further worsen the status of and overall prognosis for CV in rheumatic patients. However, data on appropriate CV screening methods for patients with systemic autoimmune diseases are scarce, and traditional algorithms may lead to an underestimation of the true CV risk. The reason for this is that these calculations were developed for the general population and thus do not take into account the effect of the inflammatory burden, as well as other chronic-disease-associated CV risk factors. In recent years, different research groups, including ours, have examined the value of different CV surrogate markers, including carotid sonography, carotid–femoral pulse wave velocity, and flow-mediated arterial dilation, in the assessment of CV risk in healthy and rheumatic populations. In particular, arterial stiffness has been thoroughly examined in a number of studies, showing high diagnostic and predictive value for the occurrence of CV events. To this end, the present narrative review showcases a series of studies examining aortic and peripheral arterial stiffness as surrogates of all-cause CV disease and atherosclerosis in patients with rheumatoid and psoriatic arthritis, as well as in systemic lupus erythematosus and systemic sclerosis. Moreover, we discuss the associations of arterial stiffness with clinical, laboratory, and disease-specific parameters.

Arterial Stiffness as a Surrogate Marker of Cardiovascular Disease and Atherosclerosis in Patients with Vasculitides: A Literature Review

“…Nevertheless, arterial stiffness enables an evaluation of the arterial tree and its elastic properties, providing additional information regarding CV burden and CVD [96] (Figure 5). Furthermore, it can serve as a screening tool for asymptomatic patients and reflect the long-term effects of chronic inflammation on the CV system [19].…”

“…In our previous review work published in this journal, discussing the diagnostic value of arterial stiffness in patients with arthritides and connective tissue diseases, we have thoroughly described the definition and the main pathogenetic mechanisms of arterial stiffness [19]. Moreover, we have discussed the most important assessment methods of arterial stiffness and their calculation formulas [19]. A summary of these points is now provided in Tables 1 and 2.…”

“…One of the most important and well-studied surrogate assessment markers of CV risk is arterial stiffness [18]. As thoroughly discussed in our previous review on the diagnostic value of arterial stiffness in patients with arthritides and connective tissue diseases [19], a plethora of methods can be employed to assess arterial stiffness. These include the augmentation index (AIx) [20], the cardio-ankle vascular index (CAVI) [21], and the β-stiffness index.…”