Accelerated Atherosclerosis in Autoimmune Rheumatic Diseases

Enhanced and premature atherosclerosis is a feature of some AIRDs and a possible feature of others because of inflammation and more specific immune mechanisms (Table 3). RA, SLE, and APS carry an increased risk for CVD. RA and SLE are characterized by an increased risk of coronary artery disease and prevalence of typical risk factors for these diseases and an increased extent of subclinical atherosclerosis. However, other factors attributed to disease activity, inflammation, and therapeutic interventions are also implicated in the higher prevalence of atherosclerosis and its complications in both diseases. APS is a prothrombotic statecharacterized by thrombosis of any vessel; however, the association of aPL with CVDs in the general population, the findings of enhanced subclinical atherosclerosis in APS patients, and the proatherogenic effect of aPL in animal models support a possible proatherogenic (in addition to prothrombotic) role of these autoantibodies. In these 3 conditions, premature atherosclerosis can be detected in some patients in its preclinical stage. Physicians thus should attempt to minimize the presence of conventional CVD risk factors in their patients and treat their patients as belonging to a group having a high risk for CVD. In SSc and PSV, although there is a high prevalence of macrovascular disease, there are few data supporting enhanced atherosclerosis in these conditions. In addition, no data yet exist to support enhanced atherosclerosis in SS. Future research is needed to determine whether these AIRDs are also associated with accelerated atherosclerosis and its manifestations.