Ateroesclerosis en enfermedades reumatológicas: ¿mito o realidad? / Atherosclerosis in rheumatic diseases: myth or reality?

ABSTRACT

The first cause of morbidity and mortality among patients with Systemic Lupus Erythematosus (SLE) and Rheumatoid Arthritis (RA) is atherosclerotic vascular disease. This has been demonstrated in several epidemiological, clinical and mortality studies. Compared with the general population, these patients have a greater number of clinical events (myocardial ischemia, angina pectoris and cerebrovascular events), more subclinical vascular diseases (detected by carotid ultrasound, stress thallium scans, echocardiograms and vascular stiffness) and a higher rate of standardized mortality ratios. Framingham oe traditional cardiovascular risk factors do not seem to be wholly responsible for the increased vascular risk. Current evidence indicates that atherosclerosis is an inflammatory disease that may be initiated by endothelial injury. A prolonged inflammatory response is characteristic of SLE and RA, and may actually be an important facilitator of atherogenesis in these patients. High levels of circulating C-reactive protein, inflammatory cytokines (ICAM-1, CCAM-1, E-selectins and IL-6), antibodies, complement-fixing immune complexes, clonal expansion of certain types of lymphocytes and others that could be the source of endothelial injury in these patients are described. This article reviews the literature relating to the epidemiology of vascular disease, related risk factors and the suggested management strategies.