Rheumatoid disease and ischaemic heart disease: insights from pathophysiology and vascular biology.
Rheumatoid disease (RD) is a multisystem inflammatory disorder, which is associated with an increased cardiovascular mortality, thought to be due to ischaemic heart disease (IHD). The precise mechanisms causing increased IHD in RD are unclear. However, there is increasing recognition that atherosclerosis is another chronic inflammatory condition, which shares several pathophysiological features with RD. For example, endothelial damage/dysfunction, platelet activation, hypercoagulability and angiogenesis are well-recognised in both disease processes. Furthermore, RD may influence traditional risk factors such as dyslipidaemia. Although the exact reasons for the increased ischaemic burden are unclear, physicians should place a high priority upon reducing cardiovascular risk in sufferers of RD. This review summarises factors that might contribute to the pathogenesis of IHD in RD. Discussion will focus upon features shared by atherosclerotic and rheumatoid processes, as well as possible interactions between RD and conventional IHD risk factors.
Bhatia
Gurbir S
GS
University Department of Medicine, City Hospital, Birmingham B18 7QH, UK.
Sosin
Michael D
MD
Khattak
Fazal H
FH
Davis
Russell C
RC
Lip
Gregory Y H
GY
D015815:Cell Adhesion Molecules / Q000378:metabolism; D016207:Cytokines / Q000378:metabolism; D004730:Endothelium, Vascular / Q000378:metabolism / Q000503:physiopathology; D006710:Homocysteine / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000378:metabolism / Q000503:physiopathology; D020782:Matrix Metalloproteinases / Q000378:metabolism; D009043:Motor Activity / Q000502:physiology; D017202:Myocardial Ischemia / Q000378:metabolism / Q000503:physiopathology*; D012214:Rheumatic Heart Disease / Q000378:metabolism / Q000503:physiopathology*; D012307:Risk Factors
D015815:Cell Adhesion Molecules; D016207:Cytokines; D006710:Homocysteine; D020782:Matrix Metalloproteinases