Abstract
Cardiovascular morbidity and mortality are becoming major health concerns for adults with inflammatory rheumatic diseases. The enhanced atherogenesis in this patient population is promoted by the exposure to traditional risk factors as well as nontraditional cardiovascular insults, such as corticosteroid therapy, chronic inflammation and autoantibodies. Despite definite differences between many adult-onset and pediatric-onset rheumatologic diseases, it is extremely likely that atherosclerosis will become the leading cause of morbidity and mortality in this pediatric patient population. Because cardiovascular events are rare at this young age, surrogate measures of atherosclerosis must be used. The three major noninvasive vascular measures of early atherosclerosis - namely, flow-mediated dilatation, carotid intima-media thickness and pulse wave velocity - can be performed easily on children. Few studies have explored the prevalence of cardiovascular risk factors and even fewer have used the surrogate vascular measures to document signs of early atherosclerosis in children with pediatric-onset rheumatic diseases. The objective of this review is to provide an overview on cardiovascular risk and early atherosclerosis in pediatric-onset systemic lupus erythematosus, juvenile idiopathic arthritis and juvenile dermatomyositis patients, and to review cardiovascular preventive strategies that should be considered in this population.
Highlights
Advances made in the field of pediatric rheumatology over the last decades have led to a significant decrease in Atherosclerosis is being increasingly recognized in adults with inflammatory rheumatic diseases but there is little information pertaining to pediatric-onset rheumatologic conditions [1]
The objectives of this review are to summarize the current state of knowledge on cardiovascular risk and accelerated atherosclerosis in pediatriconset systemic lupus erythematosus, juvenile idiopathic arthritis (JIA) and juvenile dermatomyositis (JDM), and to discuss atherosclerosis preventive strategies that should be considered in this patient population
Measuring atherosclerosis in children cardiovascular events are the true markers of atherosclerosis in rheumatic diseases, including those in adults, examining cardiovascular risk factors and/or preventive strategies for atherosclerosis are limited by sample size, and surrogate outcome markers are required
Summary
Atherosclerosis is being increasingly recognized in adults with inflammatory rheumatic diseases but there is little information pertaining to pediatric-onset rheumatologic conditions [1]. The failure of most trials of homocysteinelowering therapy to decrease cardiovascular risk in large randomized studies has cast doubt on the role of hyperhomocysteinemia in atherosclerosis [46,47] Studies of both pSLE and adult SLE patients have shown elevated plasma homocysteine levels. The previous mentioned study of CIMT was performed to document risk factors for atherosclerosis in JDM [106] These same patients had higher blood pressure values, higher prevalence of abnormal HDL-C levels and lower adiponectin levels compared with controls. A baseline pretreatment lipid level should be measured and serial measurements performed This may not apply to certain disease subtypes, such as oligoarticular JIA, where the risk of dyslipidemia is probably similar to that in the general pediatric population. The use of angiotensin-converting enzyme inhibitors and angiotensin receptor blocking agents in patients with proteinuria and/or hypertension will offer benefits by their direct action on these cardiovascular risk factors but probably via downregulation of the renin–angiotensin system, which is implicated in the genesis of atherosclerosis
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