Key Points
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Patients with rheumatic diseases have a high prevalence of cardiovascular manifestations and are at considerable risk of developing atherosclerosis
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Cardiovascular complications in patients with rheumatic diseases include vascular, valvular, myocardial, and pericardial disorders, as well as electrical abnormalities
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Multiple mechanisms can link atherosclerosis to autoimmune rheumatic disease
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Early diagnosis and appropriate preventive management are necessary to address the burden of cardiovascular disease among patients with inflammatory autoimmune diseases
Abstract
Autoimmune rheumatic diseases can affect the cardiac vasculature, valves, myocardium, pericardium, and conduction system, leading to a plethora of cardiovascular manifestations that can remain clinically silent or lead to substantial cardiovascular morbidity and mortality. Although the high risk of cardiovascular pathology in patients with autoimmune inflammatory rheumatological diseases is not owing to atherosclerosis alone, this particular condition contributes substantially to cardiovascular morbidity and mortality—the degree of coronary atherosclerosis observed in patients with rheumatic diseases can be as accelerated, diffuse, and extensive as in patients with diabetes mellitus. The high risk of atherosclerosis is not solely attributable to traditional cardiovascular risk factors: dysfunctional immune responses, a hallmark of patients with rheumatic disorders, are thought to cause chronic tissue-destructive inflammation. Prompt recognition of cardiovascular abnormalities is needed for timely and appropriate management, and aggressive control of traditional risk factors remains imperative in patients with rheumatic diseases. Moreover, therapies directed towards inflammatory process are crucial to reduce cardiovascular disease morbidity and mortality. In this Review, we examine the multiple cardiovascular manifestations in patients with rheumatological disorders, their underlying pathophysiology, and available management strategies, with particular emphasis on the vascular aspects of the emerging field of 'cardiorheumatology'.
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M.P., J.H., S.E.G., C.M.W., S.M., R.M., J.K.O., and E.L.M. researched data for the article and made substantial contributions to the content; M.P. wrote the manuscript; M.P. and A.L. reviewed and edited the manuscript before submission.
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Prasad, M., Hermann, J., Gabriel, S. et al. Cardiorheumatology: cardiac involvement in systemic rheumatic disease. Nat Rev Cardiol 12, 168–176 (2015). https://doi.org/10.1038/nrcardio.2014.206
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DOI: https://doi.org/10.1038/nrcardio.2014.206
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