The rationale for comparative studies of accelerated atherosclerosis in rheumatic diseases.
The inflammatory pathogenesis of atherosclerosis is now well-established, owing to in vitro and in vivo studies and the application of high sensitivity assays for C-reactive protein (CRP) in the general population and specific groups at risk for cardiovascular disease (CVD). In view of the complexity of inflammation-induced atherosclerosis, the rationale for comparative studies of atherogenesis in rheumatic diseases with diverse inflammatory pathogenesis seems obvious; they are human in vivo models to study inflammatory mechanisms involved in atherosclerosis and the impact of treatment. Factors implicated in atherogenesis in systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), familial Mediterranean fever (FMF) and Behçet's disease (BD) are discussed in this review. Evidence suggests that enhanced atherosclerosis causes premature cardiovascular events in the autoimmune disease, SLE, and the "high-grade" inflammatory rheumatic disease, RA. Preliminary data suggest that enhanced atherogenesis may accompany FMF in the absence of sufficient suppression of inflammation by colchicine. In the setting of BD, the role of atherosclerosis in the premature manifestation of coronary pathology has not been confirmed; coronary vasculitis and aneurysms appear to constitute the basis of myocardial infarction (MI) in BD. A variety of established and novel risk factors are believed to influence enhanced atherogenesis in rheumatic diseases. Antiphospholipid antibodies are thought to be intimately involved in atherogenesis in SLE and to a lesser extend in RA. CRP may play a more universal role in all rheumatic diseases. The application of high resolution ultrasound of peripheral arteries and other non-invasive techniques may allow targeted use of statins, ACE inhibitors, antiplatelet agents and other cardioprotective drugs in patients with rheumatic diseases, but this needs to be evaluated specifically in prospective studies.
Gasparyan
Armen Yuri
AY
Department of Rheumatology, Clinical Research Unit, Russells Hall Hospital, Dudley Group of Hospitals NHS Foundation Trust, Dudley DY1 2HQ, West Midlands, UK.
Stavropoulos-Kalinoglou
Antonios
A
Mikhailidis
Dimitri P
DP
Toms
Tracey E
TE
Douglas
Karen M J
KM
Kitas
George D
GD
D050197:Atherosclerosis / Q000209:etiology / Q000378:metabolism / Q000503:physiopathology* / Q000517:prevention & control*; D015415:Biomarkers / Q000097:blood; D018450:Disease Progression; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D012107:Research Design; D012216:Rheumatic Diseases / Q000150:complications / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology*; D012307:Risk Factors
D015415:Biomarkers; D018836:Inflammation Mediators