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Arterial Stiffness and Adult Onset Vasculitis: A Systematic Review
Alberto Lo Gullo1, Clemente Giuffrida2, Carmela Morace3
1Rheumatology Unit, Department of Medicine, ARNAS Garibaldi, Catania, Italy.
Insights
Patients with inflammatory rheumatic diseases (IRD) face higher cardiovascular risk due to chronic inflammation. Arterial stiffness, measured by pulse wave velocity (PWV), is a key biomarker for assessing and preventing cardiovascular disease (CVD) in these individuals.
Area of Science:
- Rheumatology
- Cardiology
- Vascular Biology
Background:
- Chronic inflammation in inflammatory rheumatic diseases (IRD) significantly elevates cardiovascular (CV) risk, leading to premature mortality from atherosclerotic events.
- Standardized mortality ratios are higher in IRD patients, highlighting the urgent need for improved CV risk assessment and management.
- Subclinical cardiovascular disease (CVD) is prevalent, necessitating early diagnosis to enhance long-term patient prognosis.
Approach:
- This systematic review evaluates the utility of pulse wave velocity (PWV) assessment for measuring arterial stiffness in patients with vasculitis.
- The review focuses on the role of PWV across different clinical stages of vasculitis and its application in CV risk prevention.
- Methods for noninvasive estimation of arterial stiffness, including PWV, are discussed in the context of clinical settings.
Key Points:
- Increased arterial stiffness serves as a crucial link between inflammation and heightened cardiovascular risk.
- Arterial stiffness, assessed via PWV, is an independent predictor of cardiovascular events in various populations.
- Reference values for arterial stiffness, adjusted for age and blood pressure, are being established for improved risk stratification.
Conclusions:
- Pulse wave velocity (PWV) measurement offers valuable insights for cardiovascular risk stratification in patients with vasculitis.
- Integrating PWV assessment into routine care can aid in the early detection and management of subclinical CVD in IRD.
- Optimizing CV risk prevention strategies in vasculitis patients may be enhanced through the use of arterial stiffness biomarkers like PWV.
Abstract:
Chronic inflammation represents the cornerstone of the raised cardiovascular (CV) risk in patients with inflammatory rheumatic diseases (IRD), including vasculitis. Standardized mortality ratios in these patients are higher as compared to the general population, and the excess of premature mortality is due to early atherosclerotic events. Thus, IRD patients need appropriate CV risk assessment and management according to this CV disease (CVD) burden. Adequate control of CV risk is still lacking in usual care, but early diagnosis of silent and subclinical CVD is crucial to improve the long-term prognosis of these patients. Increased arterial stiffness may provide a pathophysiological link between inflammation and increased cardiovascular risk. Several noninvasive methods are now available to estimate artery stiffness in the clinical setting, including pulse wave velocity assessment. The independent predictive value of arterial stiffness for cardiovascular events has been demonstrated in general as well as in selected populations, and reference values adjusted for age and blood pressure have been suggested. Thus, arterial stiffness is an interesting biomarker for cardiovascular risk stratification. This systematic review summarizes the additional value that PWV measurement can provide in the setting of vasculitis, with a focus in the different clinical stages and CV risk prevention. This systematic review is registered with registration number: Prospero CRD42021259603.
