Endothelial Dysfunction in Patients with Rheumatoid Arthritis: the Role of Hypertension
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INFLAMMATION AND CARDIOVASCULAR DISEASES (A KIRABO, SECTION EDITOR)
Endothelial Dysfunction in Patients with Rheumatoid Arthritis: the Role of Hypertension P. Anyfanti 1 & E. Gavriilaki 1 & S. Douma 1 & E. Gkaliagkousi 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review To review the data on the role of endothelial dysfunction and the impact of hypertension as a potent mediator of cardiovascular disease in patients with rheumatoid arthritis (RA). Recent Findings RA represents the most common autoimmune rheumatic disorder and is characterized by chronic systemic inflammation predisposing to cardiovascular complications. Cardiovascular mortality is increased among patients with RA and represents the leading cause of death. Although the exact prevalence is debated, hypertension is increased in RA. Hypertension acts synergistically with chronic inflammation and accounts, at least partially, for the increased cardiovascular morbidity in this group of patients. Endothelial dysfunction is considered a primary process in the pathogenesis of hypertension and cardiovascular diseases and contributes significantly to the development and progression of the associated micro- and macrovascular complications. Even though several studies in patients with RA have shown the presence of endothelial dysfunction with traditional methods, novel biochemical and vascular methods for the evaluation of endothelial dysfunction have been scarcely applied. In addition, it remains unclear whether and to which extent endothelial dysfunction in RA is present regardless of concomitant hypertension, even in well-controlled patients. Summary Hypertension, endothelial dysfunction, and chronic systemic inflammation appear as a mutually reinforcing triad aggravating cardiovascular risk in patients with RA. Detection of endothelial dysfunction in patients with RA in the early stages further aiming at the development of novel therapeutic targets might contribute to prevention of cardiovascular complications and remains under investigation. Keywords Rheumatoid arthritis . Endothelial dysfunction . Hypertension . Cardiovascular diseases
Introduction Rheumatic diseases are among the most common noncommunicable chronic diseases worldwide and their prevalence increases in parallel with age. Rheumatoid arthritis (RA) represents the most frequent autoimmune inflammatory rheumatic disease. In the general population, the annual incidence ranges from 10 to 50 cases per 100,000 population,
This article is part of the Topical Collection on Inflammation and Cardiovascular Diseases * P. Anyfanti [email protected] 1
3rd Department of Internal Medicine, Papageorgiou Hospital, Ring Road Nea Efkarpia, 56429 Thessaloniki, Greece
while the estimated prevalence of 0.5–1% remains relatively constant in the general population [1]. With the development of novel treatments, especially biologics, RA no longer represents a direct threat to life. By contrast, cardiovascular mortality (ischemic heart disease, strokes) represents
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