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Entzündungsbedingte kardiovaskuläre Morbidität

Pathophysiologie und Therapie

Inflammation-related cardiovascular morbidity

Pathophysiology and therapy

  • Leitthema
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Zusammenfassung

Die rheumatoide Arthritis (RA) und der systemische Lupus erythematodes (SLE) sind mit einer erhöhten Mortalität assoziiert, die hauptsächlich auf kardiovaskuläre Erkrankungen zurückzuführen ist. Das Risiko für einen Herzinfarkt ist bei RA-Betroffenen verdoppelt und bei SLE-Erkrankten sogar bis zu 7-fach erhöht.

Neben den traditionellen Risikofaktoren hat eine chronische systemische Entzündung bedeutenden Einfluss auf die Entstehung der Arteriosklerose und die Progression von einer endothelialen Dysfunktion zur Plaqueruptur mit Thrombose. Zahlreiche Studien haben gezeigt, dass die Arteriosklerose keine alleinige, passive Lipidakkumulation in den Gefäßwänden darstellt, sondern durch einen aktiven Entzündungsprozess in den Gefäßwänden charakterisiert ist. Entzündungszellen wie Makrophagen, Monozyten und T-Zellen spielen sowohl bei der Entwicklung der RA als auch der Arteriosklerose eine entscheidende Rolle.

Nach den Empfehlungen der EULAR sollen alle Patienten mit inflammatorischen Arthritiden ein jährliches Screening auf kardiovaskuläre Risikofaktoren erhalten. Alle Risikofaktoren sollten optimal eingestellt werden. Zudem gibt es genügend Evidenz, dass die entzündlichen systemischen und vaskulären Prozesse zur Reduktion des kardiovaskulären Risikos gleichzeitig reduziert werden sollten.

Abstract

Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are associated with increased mortality, largely as a consequence of cardiovascular (CV) disease. Studies found relative risk ratios of 2 for myocardial infarction in RA and up to 7 for myocardial infarction in SLE patients.

Beyond the traditional CV risk factors, chronic systemic inflammation has been shown to be a crucial factor in atherosclerosis development and progression from endothelial dysfunction to plaque rupture and thrombosis. Numerous studies have shown that atherosclerosis is not a passive process characterized by accumulation of lipids in the vessel walls, but rather represents active inflammation of the vasculature. Inflammatory cells such as macrophages, monocytes and T cells play an important role in the development of both RA and atherosclerosis.

According to the recently published EULAR recommendations for CV risk screening and management in patients with inflammatory arthritis, annual CV risk assessment is recommended for all patients with RA. Any CV risk factors identified should be optimally managed. In addition to appropriate CV risk management, aggressive suppression of the inflammatory process is recommended to further lower CV risk.

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Literatur

  1. Libby P, Ridker PM, Hansson GK, Leducq Transatlantic Network on Atherothrombosis (2009) Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol 54:2129–2138

    Article  CAS  PubMed  Google Scholar 

  2. Wong M, Toh L, Wilson A et al (2003) Reduced arterial elasticity in rheumatoid arthritis and the relationship to vascular disease risk factors and inflammation. Arthritis Rheum 48:81–89

    Article  PubMed  Google Scholar 

  3. Ridker PM, Buring JE, Shih J et al (1998) Prospective study of C-reactive protein and the risk of future cardiovascular events among apparently healthy women. Circulation 98:731–733

    CAS  PubMed  Google Scholar 

  4. Peters MJ, Halm VP van, Voskuyl AE et al (2009) Does rheumatoid arthritis equal diabetes mellitus as an independent risk factor for cardiovascular disease? A prospective study. Arthritis Rheum 61:1571–1579

    Article  PubMed  Google Scholar 

  5. Solomon DH, Curhan GC, Rimm EB et al (2004) Cardiovascular risk factors in women with and without rheumatoid arthritis. Arthritis Rheum 50:3444–3449

    Article  PubMed  Google Scholar 

  6. Kerekes G, Szekanecz Z, Dér H et al (2008) Endothelial dysfunction and atherosclerosis in rheumatoid arthritis: a multiparametric analysis using imaging techniques and laboratory markers of inflammation and autoimmunity. J Rheumatol 35:398–406

    CAS  PubMed  Google Scholar 

  7. Laurent S, Boutouyrie P, Asmar R et al (2001) Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension 37:1236–1241

    CAS  PubMed  Google Scholar 

  8. Pincus T, Callahan LF, Sale WG et al (1984) Severe functional declines, work disability, and increased mortality in seventy-five rheumatoid arthritis patients studied over nine years. Arthritis Rheum 27:864–872

    Article  CAS  PubMed  Google Scholar 

  9. Gerli R, Sherer Y, Vaudo G et al (2005) Early atherosclerosis in rheumatoid arthritis: effects of smoking on thickness of the carotid artery intima media. Ann N Y Acad Sci 1051:281–290

    Article  PubMed  Google Scholar 

  10. Emerging Risk Factors Collaboration (2010) C-reactive protein concentration and risk of coronary heart disease, stroke, and mortality: an individual participant meta-analysis. Lancet 375:132–140

    Article  Google Scholar 

  11. Peters MJ, Symmons DP, McCarey D et al (2010) EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis 69:325–331

    Article  CAS  PubMed  Google Scholar 

  12. Bertsias G, Ioannidis JP, Boletis J et al. Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (2008) EULAR recommendations for the management of systemic lupus erythematosus. Report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics. Ann Rheum Dis 67:195–205

    Article  CAS  PubMed  Google Scholar 

  13. Mosca M, Tani C, Aringer M et al (2010) European League Against Rheumatism recommendations for monitoring patients with systemic lupus erythematosus in clinical practice and in observational studies. Ann Rheum Dis 69:1269–1274

    Article  CAS  PubMed  Google Scholar 

  14. Ristić GG, Lepić T, Glisić B et al (2010) Rheumatoid arthritis is an independent risk factor for increased carotid intima-media thickness: impact of anti-inflammatory treatment. Rheumatology (Oxford) 49:1076–1081

    Google Scholar 

  15. Wallberg-Jonsson S, Ohman ML, Dahlqvist SR (1997) Cardiovascular morbidity and mortality in patients with seropositive rheumatoid arthritis in Northern Sweden. J Rheumatol 24:445–451

    CAS  PubMed  Google Scholar 

  16. Maradit-Kremers H, Nicola PJ, Crowson CS et al (2005) Cardiovascular death in rheumatoid arthritis: a population-based study. Arthritis Rheum 52:722–732

    Article  PubMed  Google Scholar 

  17. Westlake SL, Colebatch AN, Baird J et al (2010) The effect of methotrexate on cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review. Rheumatology (Oxford) 49:295–307

    Google Scholar 

  18. Albert CM, Cook NR, Gaziano JM et al (2008) Effect of folic acid and B vitamins on risk of cardiovascular events and total mortality among women at high risk for cardiovascular disease: a randomized trial. JAMA 299:2027–2036

    Article  CAS  PubMed  Google Scholar 

  19. Jacobsson LT, Turesson C, Nilsson JA et al (2007) Treatment with TNF blockers and mortality risk in patients with rheumatoid arthritis. Ann Rheum Dis 66:670–675

    Article  PubMed  Google Scholar 

  20. Gonzalez-Gay MA, De Matias JM, Gonzalez-Juanatey C et al (2006) Anti-tumor necrosis factor-alpha blockade improves insulin resistance in patients with rheumatoid arthritis. Clin Exp Rheumatol 24:83–86

    CAS  PubMed  Google Scholar 

  21. Mäki-Petäjä KM, Hall FC, Booth AD et al (2006) Rheumatoid arthritis is associated with increased aortic pulse-wave velocity, which is reduced by anti-tumor necrosis factor-alpha therapy. Circulation 114:1185–1192

    Article  PubMed  Google Scholar 

  22. Del Porto F, Laganà B, Lai S et al (2007) Response to anti-tumour necrosis factor alpha blockade is associated with reduction of carotid intima-media thickness in patients with active rheumatoid arthritis. Rheumatology (Oxford) 46:1111–1115

    Google Scholar 

  23. Ruiz-Irastorza G, Ramos-Casals M, Brito-Zeron P, Khamashta MA (2010) Clinical efficacy and side effects of antimalarials in systemic lupus erythematosus: a systematic review. Ann Rheum Dis 69:20–28

    Article  CAS  PubMed  Google Scholar 

  24. Wasko MC, Hubert HB, Lingala VB et al (2007) Hydroxychloroquine and risk of diabetes in patients with rheumatoid arthritis. JAMA 298:187–193

    Article  CAS  PubMed  Google Scholar 

  25. Schwartz GG, Olsson AG, Ezekowitz MD et al. Myocardial Ischemia Reduction with Aggressive Cholesterol Lowering (MIRACL) Study Investigators (2001) Effects of atorvastatin on early recurrent ischemic events in acute coronary syndromes: the MIRACL study: a randomized controlled trial. JAMA 285:1711–1718

    Article  CAS  PubMed  Google Scholar 

  26. Ridker PM, MacFadyen JG, Fonseca FA et al, JUPITER Study Group (2009) Number needed to treat with rosuvastatin to prevent first cardiovascular events and death among men and women with low low-density lipoprotein cholesterol and elevated high-sensitivity C-reactive protein: justification for the use of statins in prevention: an intervention trial evaluating rosuvastatin (JUPITER). Circ Cardiovasc Qual Outcomes 2:616–623

    Article  PubMed  Google Scholar 

  27. McCarey DW, McInnes IB, Madhok R et al (2004) Trial of atorvastatin in rheumatoid arthritis (TARA): double-blind, randomised placebo-controlled trial. Lancet 363:2015–2021

    Article  CAS  PubMed  Google Scholar 

  28. Teo KK, Ounpuu S, Hawken S et al. INTERHEART Study Investigators (2006) Tobacco use and risk of myocardial infarction in 52 countries in the INTERHEART study: a case-control study. Lancet 368:647–658

    Article  PubMed  Google Scholar 

  29. Knowler WC, Barrett-Connor E, Fowler SE et al (2002) Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 346:393–403

    Article  CAS  PubMed  Google Scholar 

  30. Volkmann ER, Grossman JM, Sahakian LJ et al (2010) Low physical activity is associated with proinflammatory high-density lipoprotein and increased subclinical atherosclerosis in women with systemic lupus erythematosus. Arthritis Care Res 62:258–265

    Article  Google Scholar 

  31. Metsios GS, Stavropoulos-Kalinoglou A, Panoulas VF et al (2009) Association of physical inactivity with increased cardiovascular risk in patients with rheumatoid arthritis. Eur J Cardiovasc Prev Rehabil 16:188–194

    Article  PubMed  Google Scholar 

  32. Milani RV, Lavie CJ, Mehra MR (2004) Reduction in C-reactive protein through cardiac rehabilitation and exercise training. J Am Coll Cardiol 43:1056–1061

    Article  CAS  PubMed  Google Scholar 

  33. Goldberg RJ, Katz J (2007) A meta-analysis of the analgesic effects of omega-3 polyunsaturated fatty acid supplementation for inflammatory joint pain. Pain 129:210–223

    Article  CAS  PubMed  Google Scholar 

  34. Turhanoğlu AD, Güler H, Yönden Z et al (2010) The relationship between vitamin D and disease activity and functional health status in rheumatoid arthritis. [Epub ahead of print]

  35. Autier P, Gandini S (2007) Vitamin D supplementation and total mortality: a meta-analysis of randomized controlled trials. Arch Intern Med 167:1730–1737

    Article  CAS  PubMed  Google Scholar 

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  1. Rheumazentrum Rhein-Ruhr, Klinik für Endokrinologie, Diabetologie und Rheumatologie, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Deutschland

    R. Fischer-Betz & M. Schneider

  2. Präventive und Rehabilitative Sportmedizin, Technische Universität München, München, Deutschland

    M. Halle

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Correspondence to R. Fischer-Betz.

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Fischer-Betz, R., Halle, M. & Schneider, M. Entzündungsbedingte kardiovaskuläre Morbidität. Z. Rheumatol. 69, 680–688 (2010). https://doi.org/10.1007/s00393-009-0585-5

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