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Atherosclerotic vascular disease in the autoimmune rheumatologic woman
Reto Daniel Kurmann1, Rekha Mankad1
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
Insights
Autoimmune diseases significantly increase cardiovascular risks due to inflammation, yet current risk assessments for conditions like rheumatoid arthritis and lupus are inadequate. New guidelines are needed to address this heightened cardiovascular disease burden.
Area of Science:
- Rheumatology
- Cardiology
- Immunology
Background:
- Autoimmune rheumatologic conditions are linked to higher cardiovascular morbidity and mortality.
- Diseases like rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) disproportionately affect women.
- Existing research primarily links RA and SLE to atherosclerotic cardiovascular disease (ASCVD).
Purpose of the Study:
- To highlight the inadequacy of current cardiovascular risk assessment in autoimmune patients.
- To emphasize the role of inflammation as a key factor in increased ASCVD.
- To advocate for updated guidelines addressing cardiovascular disease in this population.
Main Methods:
- Literature review focusing on autoimmune diseases and cardiovascular risk.
- Analysis of traditional and nontraditional risk factors for ASCVD.
- Evaluation of current cardiovascular risk scoring systems' limitations.
Main Results:
- Autoimmune patients face elevated cardiovascular risks beyond traditional factors.
- Inflammation is a critical, yet often unaddressed, contributor to ASCVD in these patients.
- Current risk assessment tools fail to account for the inflammatory burden.
Conclusions:
- Cardiovascular risk stratification in autoimmune diseases is suboptimal.
- Inflammation's role necessitates a re-evaluation of cardiovascular risk assessment.
- Development of new guidelines is crucial for managing cardiovascular disease in autoimmune cohorts.
Abstract:
Autoimmune rheumatologic conditions have increased cardiovascular morbidity and mortality compared to the general population. Many of these diseases occur more commonly in women, such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis, and Sjogren's. Most of the literature that has identified the link between autoimmune diseases and atherosclerotic cardiovascular disease (ASCVD) has been regarding patients with RA and SLE. The reason for the increased ASCVD is related to both traditional risk factors for atherosclerosis and nontraditional risk factors such as the burden of inflammation. Presently, our ability to adequately determinecardiovascular risk in the autoimmune patient is subpar, as scoring systems fail to take into account the role of inflammation. No present guidelines exist that take into account the increased burden of cardiovascular disease in this complex patient cohort.
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