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Cardiovascular co-morbidity in patients with rheumatic diseases
1Institute of Environmental Medicine, Unit of Immunology and Chronic Disease, Karolinska Institutet, 171 77 Stockholm, Sweden. johan.frostegard@ki.se
Insights
Cardiovascular disease (CVD) risk is elevated in rheumatic diseases due to inflammation and traditional factors. Atherosclerotic lesions in these patients may rupture more easily, increasing thrombosis risk.
Area of Science:
- Rheumatology
- Cardiovascular Medicine
- Inflammation Biology
Background:
- Atherosclerosis, a primary cause of cardiovascular disease (CVD), is increasingly understood as a chronic inflammatory condition.
- Rheumatic diseases are associated with a significantly elevated risk of CVD, notably a 50-fold increase in middle-aged women with systemic lupus erythematosus.
- Investigating CVD and atherosclerosis in rheumatic diseases offers insights into general cardiovascular pathology and addresses a critical clinical issue.
Purpose of the Study:
- To explore the interplay between rheumatic diseases and cardiovascular disease (CVD) risk.
- To identify traditional and non-traditional risk factors contributing to heightened CVD and atherosclerosis in rheumatic conditions.
- To examine the potential for increased atherosclerotic lesion rupture and thrombosis in rheumatic disease patients.
Main Methods:
- Review of existing literature on cardiovascular disease (CVD) and atherosclerosis in rheumatic diseases.
- Analysis of risk factors, including traditional (e.g., lipids) and non-traditional (e.g., inflammation, thrombosis).
- Assessment of the current state of treatment studies focusing on CVD outcomes in rheumatic diseases.
Main Results:
- Increased CVD risk in rheumatic diseases is attributed to a combination of traditional and non-traditional factors.
- Atherosclerotic lesions in rheumatic diseases may exhibit higher susceptibility to rupture compared to general populations.
- Elevated thrombosis risk, particularly in systemic lupus erythematosus, is a significant contributor to CVD.
- The precise extent to which CVD risk is a general feature across all rheumatic diseases requires further clarification.
Conclusions:
- Control of disease activity and traditional risk factors is crucial for managing CVD in rheumatic diseases.
- Further research is necessary to elucidate the role of lipid-lowering therapies like statins.
- Development of novel therapies targeting inflammation in atherosclerotic lesions is warranted for both rheumatic patients and the general population.
Abstract:
During recent years atherosclerosis, the major cause of cardiovascular disease (CVD), has been recognised as a chronic inflammatory condition in which rupture of atherosclerotic lesions appears to play a major role. The risk of CVD is raised in many rheumatic diseases. This risk is high in systemic lupus erythematosus - as much as a 50-times increase among middle-aged women has been reported. Studies on CVD and atherosclerosis in rheumatic disease could thus provide interesting information about CVD and atherosclerosis in addition to being an important clinical problem. A combination of traditional and nontraditional risk factors accounts for the increased risk of CVD and atherosclerosis in rheumatic disease. One interesting possibility is that atherosclerotic lesions in rheumatic disease are more prone to rupture than normal atherosclerotic lesions. It is also likely that increased risk of thrombosis may play an important role, not least in systemic lupus erythematosus. Further, it is not clear whether an increased risk of CVD is a general feature of rheumatic disease, or whether this only occurs among subgroups of patients. It should be emphasised that there is an apparent lack of treatment studies where CVD in rheumatic disease is the end point. Control of disease activity and of traditional risk factors, however, appears to be well founded in relation to CVD in rheumatic disease. Further studies are needed to determine the exact role of lipid-lowering drugs as statins. Hopefully novel therapies can be developed that target the causes of the inflammation in atherosclerotic lesions both in rheumatic patients and in the general population.
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