Impact of cardiovascular and immunologic variables on subclinical carotid atherosclerosis in subjects with anti-phospholipid antibodies

Abstract

Whereas some previous data on carriers with isolated antiphospholipid antibodies positivity (APP) suggested an increased risk of arterial events in this clinical setting, no data are available on subclinical atherosclerosis in this clinical setting. This article reports data on intima-media thickness of the common carotid artery (CCA-IMT) and of the Bulb (Bulb-IMT) and on the prevalence of carotid plaques in APP carriers and in subjects with antiphospholipid syndrome (APS) specifically stratifying for the presence of thrombotic manifestations, cardiovascular risk factors, antibody isotype and concomitant Systemic Lupus Erythematosus (SLE) or other autoimmune diseases.

Risk Assessment and Antithrombotic Strategies in Antiphospholipid Antibody Carriers

“…In keeping with this, aPL carriers also exhibit an earlier atherosclerosis development and a faster progression as compared with controls [ 7 , 11 , 12 ]. The relationship between aPL positivity and atherosclerosis is confirmed by Di Minno et al, showing that aPL-positive subjects have enhanced subclinical atherosclerosis, similar to that of APS patients.…”

“…Data from clinical studies strongly support the hypothesis that aPL may have a direct physiopathological role in systemic atherosclerosis, with aPL positivity being related to an increased risk of CV events regardless of the thrombotic risk [ 7 , 12 , 51 ]. Thus, it is necessary to stratify aPL carriers according to their CV risk in order to establish both prevention and interventional strategies.…”

“…Although less commonly reported than venous thromboembolism, an increased atherosclerotic burden leading to cardiovascular (CV) morbidity and mortality is also documented in APS patients [7]. Of interest, even asymptomatic aPL carriers exhibit an accelerated atherosclerosis [8][9][10][11][12], thus supporting the hypothesis of a direct pro-atherogenic effect of aPL. In keeping with this, atherosclerosis severity seems to be related to high-titer aPL and/or multiple aPL positivity [11], which are also associated with higher thrombotic risk [13,14].…”

Кардиоваскулярные Манифестации У Пациентов С Антифосфолипидным Синдромом: Вопросы Диагностики И Менеджмента

“…У цьому контексті IgG і IgM ізотипи аФЛ-АТ, ймовірно, визначають різні підгрупи тромбоемболічних подій, причому IgG є найпоширенішим серед пацієнтів із венозними тромбоемболічними подіями, а IgM -серед пацієнтів з артеріальними тромбозами [43]. Згідно з цими результатами, найбільше потовщення ТІМ і найвища поширеність атеросклеротичних бляшок на сонних артеріях були виявлені у пацієнтів з потрійною позитивністю за аФЛ-АТ: у пацієнтів із одночасною присутністю антитіл до кардіоліпінів і β 2 -ГПI, а також у пацієнтів з ізольованою позитивністю за β 2 -ГПI [44].…”

Cardiac Manifestations of Antiphospholipid Syndrome: Clinical Presentation, Role of Cardiac Imaging, and Treatment Strategies

“…85 According to these findings, the highest IMT and the highest prevalence of carotid plaques have been found in subjects with triple aPL positivity, in those with concomitant presence of aCL and aβ2GPI, and in those with isolated positivity of aβ2GPI. 86 The clinical relevance of these results can be better understood considering that subclinical atherosclerosis predicts CV events, 87,88 with a 43% increase in the risk of AMI with every 0.163 mm increase in carotid IMT 89 and a threefold increased risk for CV and cerebrovascular events in aPL carriers with increased IMT. 90 Accordingly, increased carotid artery IMT has been associated with stroke in primary APS.…”