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Cardiovascular risk in vasculitis.

Durga Prasanna Misra1, Aman Sharma2, George A Karpouzas3

  • 1Department of Clinical Immunology and Rheumatology, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, 226014, India.

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Summary

Systemic vasculitis significantly increases cardiovascular disease risk, including heart attack and stroke. Promptly controlling vasculitis activity and managing risk factors are crucial for patient outcomes.

Keywords:
Anti-neutrophil cytoplasmic antibody-associated vasculitisBehcet diseaseCardiovascular riskGiant cell arteritisSystemic vasculitisTakayasu arteritis

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Area of Science:

  • Cardiovascular Medicine
  • Rheumatology
  • Immunology

Background:

  • Systemic vasculitis encompasses a group of rare diseases characterized by inflammation of blood vessels.
  • Cardiovascular disease (CVD) is a significant complication, impacting morbidity and mortality in patients with vasculitis.
  • Understanding the specific CVD risks associated with different vasculitis types is essential for effective management.

Purpose of the Study:

  • To review the cardiovascular disease burden in systemic vasculitis.
  • To identify key risk factors, biomarkers, and therapeutic strategies for CVD in vasculitis patients.
  • To provide a comprehensive overview of cardiovascular complications across various vasculitis syndromes.

Main Methods:

  • Literature review of studies on cardiovascular disease in systemic vasculitis.
  • Analysis of data on incidence, risk factors, and outcomes of cardiovascular events.
  • Synthesis of current therapeutic recommendations for managing cardiovascular risk and disease activity.

Main Results:

  • Ischemic heart disease and stroke are intrinsic to Kawasaki disease, Takayasu arteritis, Giant Cell Arteritis (GCA), and Behcet's disease.
  • Anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV) and cryoglobulinemic vasculitis show increased risk of ischemic heart disease and stroke.
  • Venous thromboembolism risk is elevated in Behcet's disease, AAV, polyarteritis nodosa, and GCA, with peak risk around diagnosis.

Conclusions:

  • Cardiovascular risk is substantially elevated in systemic vasculitis, driven by traditional and disease-specific factors.
  • Aggressive control of vasculitis disease activity, particularly in AAV and GCA, is paramount to mitigate cardiovascular events.
  • Therapeutic strategies include aspirin/statins for ischemic events and immunosuppression for venous thromboembolism in Behcet's disease.