Elsevier

Canadian Journal of Cardiology

Volume 27, Issue 2, March–April 2011, Pages 174-182
Canadian Journal of Cardiology

Review
Chronic Inflammatory Diseases and Cardiovascular Risk: A Systematic Review

https://doi.org/10.1016/j.cjca.2010.12.040Get rights and content

Abstract

Despite recent advancements in the treatment of coronary artery disease (CAD), it remains the number one cause of death in the world. While traditional risk factors partially account for the development of CAD, other novel risk factors have recently been implicated. Specifically, chronic inflammation has been postulated to play a role in the development and propagation of this disease. The purpose of this systematic review is to examine the available evidence to determine if patients with chronic inflammatory diseases have higher rates of cardiovascular disease. A MEDLINE search was conducted for articles published between 1980-2009. We focused on studies that assessed hard cardiovascular endpoints in subjects with chronic inflammatory conditions such as systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, polymyositis/dermatomyositis, and inflammatory bowel disease. Although largely based on small studies, our review indicates that patients with chronic inflammatory conditions are likely at elevated risk for the development of CAD. Further research consisting of prospective cohort studies is needed to better quantify this risk.

Résumé

En dépit des récents progrès dans le traitement de la maladie coronarienne (MC), il n'en demeure pas moins qu'elle est la première cause de décès dans le monde. Bien que les facteurs de risque traditionnels soient en partie pris en compte dans le développement de la MC, d'autres nouveaux facteurs de risque ont récemment été impliqués. Particulièrement, l'inflammation chronique est appelée à jouer un rôle dans le développement et la propagation de la maladie. Le but de cette revue systématique est de vérifier les preuves disponibles pour déterminer si les patients ayant des maladies inflammatoires chroniques ont des risques plus élevés de maladies cardiovasculaires. Une recherche MEDLINE a été effectuée dans des articles publiés entre 1980 et 2009. Nous ciblons des études qui établissent des critères d'évaluation cardiovasculaire forts chez des sujets ayant des maladies inflammatoires chroniques comme le lupus érythémateux systémique, l'arthrite rhumatoïde, la spondylarthrite ankylosante, l'arthrite psoriasique, la polymyosite et la dermatomyosite, et la maladie intestinale inflammatoire. Bien que fondée sur des petites études, notre revue démontre que les patients ayant des maladies inflammatoires chroniques sont probablement à risque élevé de développer une MC. D'autres recherches consistant en des études de cohorte sont nécessaires pour mieux évaluer ce risque.

Section snippets

Methods

Studies were identified via a MEDLINE search using the following key words: “inflammation,” “chronic inflammatory diseases,” “atherosclerosis,” “coronary artery disease,” “coronary heart disease,” “ischemic heart disease,” and “myocardial infarction” (Fig. 1 and Appendix). Assessment for inclusion of studies was performed independently by two authors (I.R. and J.G.). Disagreements between reviewers were resolved by consensus. The last search was conducted in June 2010, and studies were screened

Systemic lupus erythematosus

SLE is a chronic inflammatory multisystem disease of unknown etiology (Table 1). It predominantly affects young women and occurs in ∼1 per 1000 white women and ∼1 per 250 African American women.13, 14, 15 Several studies have examined the relationship between SLE and cardiovascular endpoints. In a retrospective case-control study of 8742 patients with SLE, compared to 43,700 control subjects, Ward16 found significantly higher rates of admission for acute MI among patients with SLE. The effect

Mechanisms of disease: endothelial dysfunction and the inflammatory cascade endothelial dysfunction

The normal endothelium produces a vasodilatory response to ischemia. This response is largely mediated by nitric oxide (NO). Endothelial dysfunction refers to either a blunted vasodilatory response or paradoxical vasoconstriction.32 It is associated with diminished production or activity of NO as well as an imbalance of other relaxing and constricting factors such as angiotensin II, endothelin-1, and reactive oxygen species.32, 33, 34, 35 In addition to its vasomotor effects, endothelial

Disclosures

The authors have no conflicts of interest to disclose.

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