SHORT SURVEYAtherosclerosis and connective tissue diseases
Section snippets
Epidemiologiy of cardiovascular and cerebrovascular disease in patients with conenctive tissue disease: the example of SLE
SLE, a disease with a marked predominance in women, is commonly responsible for angina and myocardial infarction, which can be fatal. As early as 1976, Urowitz et al. showed that mortality over time is bimodal in patients with SLE: in their series of 110 patients, there were six early deaths related to SLE activity or to infectious complications and five deaths after a mean follow-up of 8.6 years, of which four were caused by myocardial infarction. This contribution of cardiovascular disease to
Atherosclerosis and rheumatoid arthritis
Although more fragmentary, data on rheumatoid arthritis (RA) are consistent with those on SLE: several large epidemiological studies found excess cardiovascular mortality in RA patients as compared to controls 33, 34, 35, 36, 37, 38, 39. This excess mortality, expressed as the standardized mortality ratio (SMR), ranged from 1.3 to 3.64, with this higher value being obtained in women aged 15 to 49 years. Myocardial infarction was the main source of excess mortality (SMR, 1.54). Whether RA
Main risk factors for atherosclerosis
Prospective epidemiological studies conducted from 1947 onward, such as the Framingham study, have played a major role in confirming the main risk factors for atherosclerosis, some of which, including hypercholesterolemia, were first identified in 1913 by the Russian pathologists Anitschkov and Chalatov. Table III recapitulates the risk factors identified in these studies. Recently identified risk factors are biochemical or immunological characteristics whose relative impact requires
Lupus and risk factors for atherosclerosis
Classic risk factors for atherosclerosis are often present in SLE patients, as shown by a prospective study in a cohort of 264 patients 〚2〛 with a total number of visits of 3,000. Nine factors yielded significant odds ratios as predictors of CAD (table IV). The cumulative glucocorticoid dose was a risk factor, whereas a high daily dosage was not 〚2〛. Hypercholesterolemia was also a risk factor for CAD in the multiple logistic regression model; the mean maximal level was 2.72 g/L in patients
Rheumatoid arthritis and risk factors for cardiovacular events
Studies of classic risk factors for CAD in patients with RA found that the following factors were associated with excess cardiovascular mortality: male gender, older age at RA onset, arterial hypertension, a previous cardiovascular event, and a numerous joints with inflammation 〚44〛.
Other classic risk factors seem associated with ischemic cardiovascular events of any kind 〚39〛: high body mass index, elevations in parameters for inflammation (erythrocyte sedimentation rate, C-reactive protein,
Pathogenesis of atherosclerosis
Atherosclerosis is a multifactorial disease. Genetic, environmental, metabolic, inflammatory, infectious, and immunological factors have been implicated 〚47〛. Although plaque build-up in arteries results from accumulation of lipids within the artery wall, hyperlipidemia is not the sole determinant of atherosclerosis. One of the events that initiates the vascular lesion is penetration of atherogenic lipoproteins within the arterial intima, where they remain captive in the subendothelial matrix
Chronic inflammation
Inflammatory reactions associated with vascular alterations seem to play a major role in the development of atheromatous plaque 〚50〛. Epidemiological studies have established that a high C-reactive protein level is an independent risk factor for myocardial infarction and stroke in men with or without other risk factors 〚51〛. The efficacy of statins in secondary prevention may be ascribable in part to their ability to return C-reactive protein levels to normal 〚52〛 and in part to their
How can cardiovascular morbidity/mortality be reduced in patients with connective tissue disease?
A retrospective study in 24 Canadian patients (18 women and six men) with a history of myocardial infarction or unstable angina identified the following risk factors: hypertension (n = 16), obesity (n = 19), smoking (n = 16), hypercholesterolemia (n = 11), glucocorticoid use (n = 22), hyperglycemia (n = 4), and cardiac involvement with SLE (n = 4). 〚92〛. Only half these patients had been offered appropriate risk reduction interventions.
Clearly, early prevention of atheroma is essential given
Conclusion
Connective tissue disease, most notably SLE and antiphospholipid syndrome, are characterized by a high incidence of ischemic coronary and cerebral events. These events are associated not only with the classic risk factors but also with the treatments used (glucocorticoids, methotrexate, etc.) and with the inflammatory disease itself, which exhibits many etiopathogenic similarities with atheroma. The major excess mortality from atheroma seen in patients with connective tissue disease requires
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Cited by (27)
Mean platelet volume and β-thromboglobulin levels in familial mediterranean fever: Effect of colchicine use?
2012, European Journal of Internal MedicineCitation Excerpt :In recent years the possible causative role of systemic inflammation in some rheumatic diseases on atherosclerosis development have been investigated [9–11]. Increased mortality rates were determined to be associated with early atherosclerosis development in patients with Systemic Lupus Erythematosus, antiphospholipid syndrome and rheumatoid arthritis [12]. A few of the recent studies revealed that risk of atherosclerosis had increased in FMF patients [13–16].
Anti-CRP antibodies in lupus
2010, Revue du Rhumatisme (Edition Francaise)Anti-CRP antibodies in systemic lupus erythematosus
2010, Joint Bone SpineRheumatoid Arthritis
2010, Current Clinical Medicine: Expert Consult Premium Edition - Enhanced Online Features and PrintAuto-antibodies do not influence development of atherosclerotic plaques in rheumatoid arthritis
2008, Joint Bone SpineCitation Excerpt :Several diagnostic methods such as carotid ultrasound (US), myocardium perfusion scintillography, and coronary artery angiography showed that rheumatoid arthritis (RA) patients have a high frequency of carotid atherosclerosis, cerebrovascular, ischemic, and coronary disease [1–5]. In fact, a higher risk of cardiovascular events was observed in RA compared to general population [6] and attention should be given to conventional risk factors [6–8]. In normal population, besides the important role of dyslipoproteinemia, systemic arterial hypertension and smoking in the pathogenesis of atherosclerosis, some markers of systemic inflammation such as fibrinogen and C-reactive protein (CRP) have also been implicated to this risk which supports the notion that this process is a consequence of an inflammatory process in artery vessels [9,10].
Severe atherosclerosis in rheumatoid arthritis and hyperhomocysteinemia: Is there a link?
2008, Joint Bone SpineCitation Excerpt :Finally, anticoagulant and antiplatelet therapy was given, as well as a statin. RA is associated with a high risk of cardiovascular morbidity and mortality [1–4]. The standardized mortality ratio for cardiovascular disease has ranged across studies from 1.3 to 2.4 in RA patients [1,3,4].