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Review
. 2021 Sep 27;10(19):4427.
doi: 10.3390/jcm10194427.

Autoimmune Rheumatic Diseases and Vascular Function: The Concept of Autoimmune Atherosclerosis

Ahmed M Hedar  1   2 , Martin H Stradner  3 , Andreas Roessler  1 , Nandu Goswami  1   4
Affiliations
Review

Autoimmune Rheumatic Diseases and Vascular Function: The Concept of Autoimmune Atherosclerosis

Ahmed M Hedar et al. J Clin Med. .

Abstract

Autoimmune rheumatic diseases (AIRDs) with unknown etiology are increasing in incidence and prevalence. Up to 5% of the population is affected. AIRDs include rheumatoid arthritis, system lupus erythematosus, systemic sclerosis, and Sjögren's syndrome. In patients with autoimmune diseases, the immune system attacks structures of its own body, leading to widespread tissue and organ damage, which, in turn, is associated with increased morbidity and mortality. One third of the mortality associated with autoimmune diseases is due to cardiovascular diseases. Atherosclerosis is considered the main underlying cause of cardiovascular diseases. Currently, because of finding macrophages and lymphocytes at the atheroma, atherosclerosis is considered a chronic immune-inflammatory disease. In active inflammation, the liberation of inflammatory mediators such as tumor necrotic factor alpha (TNFa), interleukine-6 (IL-6), IL-1 and other factors like T and B cells, play a major role in the atheroma formation. In addition, antioxidized, low-density lipoprotein (LDL) antibodies, antinuclear antibodies (ANA), and rheumatoid factor (RF) are higher in the atherosclerotic patients. Traditional risk factors like gender, age, hypercholesterolemia, smoking, diabetes mellitus, and hypertension, however, do not alone explain the risk of atherosclerosis present in autoimmune diseases. This review examines the role of chronic inflammation in the etiology-and progression-of atherosclerosis in autoimmune rheumatic diseases. In addition, discussed here in detail are the possible effects of autoimmune rheumatic diseases that can affect vascular function. We present here the current findings from studies that assessed vascular function changes using state-of-the-art techniques and innovative endothelial function biomarkers.

Keywords: antioxidized LDL antibodies; atherosclerosis; autoimmune disease; endothelial dysfunction; nitric oxide; oxidized LDL.

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Conflict of interest statement

No conflict of interest.

Figures

Figure 1
Figure 1
Overview of studies selection.
Figure 2
Figure 2
An overview of roles of traditional versus nontraditional risk factors in atherosclerosis in autoimmune diseases.
Figure 3
Figure 3
Pathogenesis of atherosclerosis based on possible association with immune changes accompanying inflammation. Legend: VLDL: very-low-density lipoprotein; LDL: low-density lipoprotein; HDL: high-density lipoprotein; TH1: T helper cell 1; TH17: T helper 17; T reg: T regulator cells; NO: nitric oxide; ADMA: asymmetric dimethylarginine; ++ stimulate; −− inhibit.
Figure 4
Figure 4
Overview of diagnostic techniques and biomarkers that are currently used in autoimmune rheumatic disease. Legend: PiHDL: proinflammatory, high-density lipoprotein; LDL: low-density lipoprotein; ADMA: asymmetric dimethylarginine; PET scan: positron emission tomography scan; FMD: flow mediated dilation; CT Scan: computerized tomography; MRI: magnetic resonance imaging.
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