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Atherosclerosis in rheumatoid arthritis and systemic lupus erythematosus

Haque, Sahenaa; Mirjafari, Hodaa; Bruce, Ian Na,b

doi: 10.1097/MOL.0b013e328304b65f
Hyperlipidaemia and cardiovascular disease: Edited by Paul N. Durrington
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Purpose of review Our aim was to review recent studies that address the increased risk of atherosclerosis and coronary heart disease in patients with rheumatoid arthritis and systemic lupus erythematosus. We examine the strength of this association, how inflammation mediates this increased risk and what impact therapies may have.

Recent findings Atherosclerosis is more prevalent and accelerated in both conditions. Indeed the process may actually precede the onset of clinical inflammatory disease. Metabolic alterations include insulin resistance and the generation of proinflammatory HDL. In addition, inflammatory mechanisms central to both rheumatoid arthritis and systemic lupus erythematosus such as macrophage activation, interferon-1 and complement deficiency may contribute to atherogenesis. There is still no consensus as to the value of primary preventive strategies in these conditions. However, drugs such as hydroxychloroquine seem to modify coronary heart disease risk and may improve survival. The recently developed antitumour necrosis factor drugs may also reduce coronary heart disease risk but biomarker studies to date have been inconclusive.

Summary There is an urgent need for clinical trials to examine both the lipid-lowering and inflammatory hypotheses of atherosclerosis in rheumatoid arthritis and systemic lupus erythematosus. Novel targeted therapies in development may also have a major impact on future coronary heart disease risk in these conditions.

aarc Epidemiology Unit, School of Translational Medicine, The University of Manchester, UK

bThe Kellgren Centre for Rheumatology, Central Manchester and Manchester Children's University Hospitals NHS Trust, Manchester, UK

Correspondence to Dr Ian N. Bruce, MD, FRCP, Reader and Honorary Consultant in Rheumatology, arc Epidemiology Unit, School of Translational Medicine, The University of Manchester M13 9PT, UK Tel: +44 161 275 5993; fax: +44 161 276 8690; e-mail: ian.bruce@manchester.ac.uk

© 2008 Lippincott Williams & Wilkins, Inc.