Cardiovascular Involvement in Autoimmune Diseases

Table 4

Traditional and nontraditional risk factors associated with CVD and SS.

Risk factor		Comment	Reference
Traditional risk factors
Dyslipidemia		(i) High prevalence of hyperlipidemia and low HDL are associated with CVD and first-degree heart block.; (ii) SS patients showed 1.5-fold higher prevalence of hypertriglyceridemia.	[12, 42–44, 210, 420]
T2DM		It is associated with CV compromise in SS patients.	[210]
Advanced age		Age is a predictor for valve compromise	[45]
Nontraditional risk factors
	Systemic compromise	Articular, renal, liver, peripheral neuropathy, CNS, joint and gastrointestinal involvement, and parotid enlargement are associated with stroke, IHD and lower flow-mediated vasodilation; .	[12, 42, 210]
	Polyautoimmunity	SS patients with APS were significantly associated with APLA in thrombotic events.	[41]
SS-associated	Autoantibodies	(i) SS-A is associated with stroke, IHD, and carotid thickening.; (ii) SS-B is related to first-degree heart block, valve compromise, and lower nitrate mediated vasodilation.; (iii) APLA and lupus anticoagulant are associated with thrombotic events.; (iv) ACLA IgG is associated with arrhythmias; (v) RF is related to lower nitrate mediated vasodilation.; (vi) Anti-HDL.	[12, 41–43, 210, 211, 420]
	Long duration of disease	Longer duration of the disease is associated with stroke and IHD.	[210, 420]
	Chronic proinflammatory state	Elevated CRP is associated with stroke and IHD	[43, 210]
	Glucocorticoids	(i) Steroid use is associated with stroke and IHD; (ii) Patients with GCs showed a higher frequency of HTN, T2DM, and elevated TAG.	[42, 210]
Others	Hematological alterations	(i) Hypogammaglobulinemia, leukopenia, thrombocytopenia, and s-VCAM-1 are associated with thrombotic events and lower nitrate mediated vasodilation.; (ii) Low C4 and cryoglobulinemia are predictors for valve injury	[12, 42, 45, 210, 211, 420]

ACLA: anticardiolipins antibodies; anti-HDL: anti-high-density lipoprotein antibodies; APLA: antiphospholipid antibodies; APS: antiphospholipid syndrome; CNS: central nervous system; CRP: c-reactive protein; CV: cardiovascular; CVD: cardiovascular disease; GCs: glucocorticoids; HDL: high-density lipoprotein cholesterol; HTN: hypertension; IHD: ischemic heart disease; RF: rheumatoid factor; SS-A: anti-Ro/SSA antibodies; SS-B: anti-La/SSB antibodies; SS: Sjõgren’s syndrome; s-VCAM: soluble vascular cellular adhesion molecules; TAG: triglycerides; T2DM: type 2 diabetes mellitus.