Cardiovascular disease prevention in individuals with underlying chronic inflammatory disease

Abstract

Purpose of reviewPatients with chronic inflammatory disease have an increased risk of cardiovascular disease. This article reviews the current evidence of cardiovascular prevention in three common systemic inflammatory disorders (SIDs): psoriasis, rheumatoid arthritis, and systemic lupus erythematosus. Recent findingsGeneral population cardiovascular risk assessment tools currently underestimate cardiovascular risk and disease-specific risk assessment tools are an area of active investigation. A disease-specific cardiovascular risk estimator has not been shown to more accurately predict risk compared with the current guidelines. Rheumatoid arthritis-specific risk estimators have been shown to better predict cardiovascular risk in some cohorts and not others. Systemic lupus erythematosus-specific scores have also been proposed and require further validation, whereas psoriasis is an open area of active investigation. The current role of universal prevention treatment with statin therapy in patients with SID remains unclear. Aggressive risk factor modification and control of disease activity are important interventions to reduce cardiovascular risk. SummaryA comprehensive approach that includes cardiovascular risk factor modification, control of systemic inflammation, and increased patient and physician awareness is needed in cardiovascular prevention of chronic inflammation. Clinical trials are currently underway to test whether disease-specific antiinflammatory therapies will reduce cardiovascular risk.

The Impaired Elasticity of Large Arteries in Systemic Sclerosis Patients

“…Rheumatic diseases, such as rheumatoid arthritis (RA), were widely studied as independent risk factors for the increase in cardiovascular risk, due to the chronic inflammatory state [ 33 , 34 , 35 ]. In the literature, increased incidence of major adverse cardiovascular events was largely demonstrated for RA patients, in association with long disease duration and scarce disease control [ 33 , 34 , 35 ]. Moreover, it is well known that the chronic inflammatory state leads to endothelial activation/lesion and surface expression of adhesion molecules for migration of leukocytes [ 36 ].…”

“…Moreover, it is well known that the chronic inflammatory state leads to endothelial activation/lesion and surface expression of adhesion molecules for migration of leukocytes [ 36 ]. The inflammatory infiltration of atherosclerotic plaques and progression of vascular injury through the inflammatory pathway may be considered as the primum movens of premature atherosclerosis in RA patients [ 33 , 34 , 35 , 36 ].…”

Cardiovascular Implications of Immune Disorders in Women

“…Importantly, standard ASCVD risk prediction scores often underestimate risk in populations affected by immune conditions, particularly in women. [8][9][10][11][12][13][14][15] This underestimation has the potential to misclassify women with immune conditions into lower risk categories, with subsequent underutilization of risk reduction strategies and decreased awareness of increased ASCVD risk by women and their health care providers. This review specifically focuses on ASCVD as an adverse cardiovascular consequence of immune dysregulation triggered by conditions with varying prevalence by sex (globally): autoimmune conditions (female predominant), HIV (male-female equivalent), and HCV (male predominant).…”

More than skin deep: Recognizing cardiovascular co-morbidities in medical dermatology. A Fellow's Voice

“…I asked more questions about her family history of heart disease until she snapped, “why does that matter here?” Our young patient deepened my interest in disorders like psoriasis, systemic lupus erythematosus (SLE), and dermatomyositis – multi-system, inflammatory disorders in medical dermatology that elevate cardiovascular (CV) risk [ [1] , [2] , [3] ]. I informed her that inflammation in psoriasis may exacerbate or accelerate atherosclerotic CV disease (ASCVD) independent of traditional CV risk factors [4] .…”