Atherosclerotic vascular disease in the autoimmune rheumatologic woman

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.

Figure 1

Diagram depicting the inflammatory pathways by which mediators of synovitis may alter arterial biology and risk factors for atherosclerosis. PAI‐1 = plasminogen activator inhibitor‐1; TNF = tumor necrosis factor; CRP = C‐reactive protein; IFN = interferon; IL = interleukin (Reprinted with permission from The American Journal of Medicine)

Figure 2

Survival among Rochester, Minnesota residents first diagnosed with rheumatoid arthritis (RA) between January 1, 1955 and December 31, 1994 (n = 609), compared with expected survival (Reprinted with permission from Arthritis & Rheumatism)

Figure 3

Effect of body mass index (BMI), categorized as low (< 20 kg.m²⁰), normal (20‐30 kg/m²), and high (> 30 kg/m²) on cardiovascular mortality in rheumatoid arthritis (RA) and non‐RA cohorts. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated from a Cox regression model adjusted for a personal history of cardiac disease, smoking status, and presence of diabetes mellitus, hypertension, and malignancies (Reprinted with permission from Arthritis & Rheumatism)