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Inflammation-mediated rheumatic diseases and atherosclerosis
  1. SUSAN MANZI,
  2. MARY CHESTER M WASKO
  1. SUSAN MANZI
  1. Department of Medicine, University of Pittsburgh Medical Centre, Pittsburgh, PA, USA
  2. Department of Epidemiology, Graduate School of Public Health, Pittsburgh, PA, USA
  1. Dr Manzi, Suite 502, Liliane Kaufmann Building, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA Email:sxm6+{at}pitt.edu

https://doi.org/10.1136/ard.59.5.321

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    For over 20 years, premature coronary heart disease has been recognised as a major determinant of morbidity and mortality in patients with systemic lupus erythematosus (SLE).1-4 Less appreciated is the fact that the same holds true for patients with rheumatoid arthritis (RA).5-7 These two autoimmune diseases share a propensity to target women of childbearing age and a treatment armamentarium that includes corticosteroids and other immunosuppressive agents. Despite clear distinctions in pathophysiology, the immune dysfunction unique to each disease results in a chronic inflammatory state, which may have implications for the atherogenesis seen in these young patients. As we compare and contrast potential cardiovascular risk factors in these two autoimmune diseases, we may further our understanding of why these young women are at high risk for premature atherosclerosis.

    Epidemiology of cardiovascular disease in SLE and RA

    Women with SLE have a high incidence of coronary heart disease.1-4 Several investigators have convincingly shown that women with SLE under the age of 45 are at substantially increased risk of ischaemic heart disease.1 ,4 We reported that women with SLE aged 35–44 were over 50 times more likely to have a myocardial infarction than were women of similar age from a population based sample (rate ratio = 52.43, 95% CI 21.6 to 98.5).1In contrast, women with SLE in the 45–64 year age group were only two to four times more likely to have a myocardial infarction than women without SLE of the same age. We also found a small decline in the incidence rates for myocardial infarction in women with SLE aged 45–54 compared with those having the same diagnosis aged 35–44. The reasons for this are unclear. A difference in overall survival is an unlikely explanation as mortality rates from all causes were not significantly different between women in these two age strata. A …

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