Cardiovascular Involvement in Autoimmune Diseases

Table 3

Traditional and nontraditional risk factors associated with CVD and APS.

Risk factor	Comment	Reference
Traditional risk factors
Metabolic syndrome	The most common risk factors are hypertriglyceridemia, low HDL levels, and visceral obesity.	[409, 410]
Hyperlipidemia	High levels of APLA may be a marker for earlier endothelial damage caused by hyperlipidaemia.	[410, 411]
T2DM	It is associated with cardiovascular disease among APS patients. It did not show any difference between APS patients and the general population.	[410, 412]
Smoking	CVD risk factor increases risk of AT.	[410, 412]
Obesity	Increases the risk of insulin resistance and MetS.	[410, 412]
HTN	Increases risk of ischemic events and CVD.	[410, 412]
Sedentary lifestyle	Increases risk of obesity and comorbidities, propending CVD.	[410, 412]
Nontraditional risk factors
APS per se	Patients with primary APS have a high prevalence of carotid IMT and a decreased lumen diameter. IMT in primary APS may be associated with stroke. Patients with primary APS with IMT must be considered as carriers of atherosclerosis.	[204]
Autoantibodies	(i) ACLA are associated with a higher risk of venous thrombosis and arterial thrombosis.; (ii) Lupus anticoagulant is a major risk factor for arterial thrombotic events.; (iii) Immunoinflammatory mechanisms, primarily APLA, have an outstanding role in APS-related vasculopathies.; (iv) Patients having APLA and AT may have greater risk for ischemic events than patients with the same degree of AT but without APLA.; (v) 2GPI is abundantly present in the atherosclerotic plaque.; (vi) Anti-2GPI and ACLA may be involved in CAD and stroke.; (vii) CAD and PVD occurred more often in patients with elevated serum levels of IgG or IgM APLA, including ACLA or anti-2GPI.	[145, 186, 204, 413–419]

ACLA: anticardiolipins antibodies; anti-2GPI: anti-2 glycoprotein I antibodies; APLA: antiphospholipid antibodies; APS: antiphospholipid syndrome; AT: atherosclerosis; 2GPI: 2 glycoprotein I; CAD: coronary artery disease; CVD: cardiovascular disease; HDL: high-density lipoprotein; HTN: hypertension; IMT: intima-media thickness; MetS: metabolic syndrome; PVD: peripheral vascular disease; T2DM: type 2 diabetes mellitus.