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Mechanisms of Disease: atherosclerosis in autoimmune diseases

Abstract

Atherosclerosis is a pathologic process affecting blood vessels, which leads to the development of cardiovascular disease. The immune system is involved in atherogenesis and in the pathogenesis of atherosclerosis. Several autoimmune rheumatic conditions, including rheumatoid arthritis, systemic lupus erythematosus and antiphospholipid syndrome, are characterized by enhanced atherosclerosis and consequently higher cardiovascular morbidity and mortality rates. Enhanced atherosclerosis, in these diseases, can manifest as overt cardiovascular diseases, but could be detected at an earlier stage by identification of abnormal endothelial function and arterial intima–media thickening. Both classical and nonclassical risk factors are presumed to contribute to atherosclerosis progression in rheumatic diseases. As atherosclerosis can be considered to be an immune-mediated process, several experimental strategies exist for its immunomodulation, including induction of immune tolerance. In this article, we briefly review the contribution of autoimmune elements, such as autoreactive lymphocytes and autoantibodies to atherosclerosis and discuss the nature of atherosclerosis in autoimmune rheumatic diseases.

Key Points

  • Autoimmune rheumatic diseases are characterized by enhanced atherosclerosis, which leads to cardiovascular disease

  • Some forms of atherosclerosis can be detected at the preclinical stage

  • Both cellular and humoral components of the immune system are involved in the pathogenesis of atherosclerosis

  • Classical and nonclassical risk factors for atherosclerosis are associated with accelerated atherosclerosis in autoimmune rheumatic diseases

  • Atherosclerosis can be immunomodulated in experimental models in various ways, which include induction of immune tolerance

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Figure 1: Early in the development of atherosclerosis, low-density-lipoprotein cholesterol becomes oxidized, which results in endothelial cell dysfunction and the expression of vascular cell adhesion molecules and chemokines.

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Correspondence to Yehuda Shoenfeld.

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Sherer, Y., Shoenfeld, Y. Mechanisms of Disease: atherosclerosis in autoimmune diseases. Nat Rev Rheumatol 2, 99–106 (2006). https://doi.org/10.1038/ncprheum0092

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  • DOI: https://doi.org/10.1038/ncprheum0092

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