Cardiovascular Disease in Large Vessel Vasculitis: Risks, Controversies, and Management Strategies

Area of Science:

• Cardiovascular Medicine
• Rheumatology
• Immunology

Background:

• Takayasu's arteritis (TAK) and giant cell arteritis (GCA) are primary large vessel vasculitides (LVV).
• Both conditions share vascular targets, clinical features, and histopathology.
• However, they affect distinct patient demographics: TAK affects young women, predominantly of Asian heritage, while GCA affects elderly individuals of northern European ancestry.

Purpose of the Study:

• To compare and contrast cardiovascular diseases (CVD) in patients with TAK and GCA.
• To explore the prevalence, risk factors, and mechanisms of CVD events in these patient groups.
• To understand the roles of active vasculitis, vascular damage, and accelerated atherosclerosis in CVD development.

Main Methods:

• This review synthesizes existing literature on CVD in TAK and GCA.
• Comparative analysis of epidemiological data, clinical presentations, and pathophysiological mechanisms.
• Discussion of current controversies and potential mitigation strategies for CVD in LVV.

Main Results:

• Cardiovascular diseases are significantly elevated in patients with LVV.
• Differences in CVD prevalence and risk factors exist between TAK and GCA patients, influenced by demographics and underlying disease processes.
• Both active vasculitis and accelerated atherosclerosis contribute to CVD risk.

Conclusions:

• Understanding the distinct CVD profiles in TAK and GCA is crucial for patient management.
• Further research is needed to elucidate the interplay between vasculitis, vascular damage, and atherosclerosis.
• Developing targeted mitigation strategies can help reduce the burden of CVD in patients with large vessel vasculitis.