Abstract
Cardio-vascular risk (CVR) stratification tools have been implemented in clinical practice to guide management decision for primary prevention of cardiovascular disease. Less is known about how we can optimally estimate the CVR in children and adolescents or about the reliability of the risk stratification tools validated in adult populations. Chronic inflammation associated with autoimmune rheumatic disease (ARD) drives an increased risk for accelerated atherosclerosis in patients of all ages. Although the research is less advanced than in adult populations, it is recognized that young people with ARDs with childhood-onset have increased CVR compared to age-matched healthy controls, as supported by studies investigating lipid biomarker profile and markers of endothelial dysfunction. Further research is needed to address the unmet need for adequate CVR identification and management strategies in young people in general, and in those with underlying chronic inflammation in particular. This perspective paper explores various challenges in adequately identifying and managing CVR in younger populations and potential directions for future research.
Highlights
Ischemic cardiovascular disease (CVD) is an umbrella term which comprises disorders of the heart and blood vessels caused by atherosclerosis, characterized by build-up of lipid deposits within the large and medium arteries leading to increased blood vessel stiffness and impaired blood supply to vital organs, as well as increased risk of blood clots
ARD, autoimmune rheumatic diseases; body mass index (BMI), bone mass index; CVR, cardiovascular risk; HDL, high density lipoprotein; hsCRP, high sensitivity C-reactive protein; LDL, low density lipoprotein; SD, standard deviation; SLE, systemic lupus erythematosus. #Systematic Coronary Risk Evaluation (SCORE)-2 is calibrated according to each European country CVD mortality risk. ±Excluded from the updated Framingham risk score (FRS); *heart attack, angina, stroke, or transient ischemic accident. **QRISK2 tested in rheumatoid arthritis (RA) patients aged 40–75 and QRISK3 tested in SLE patients aged 35–44. ***RA patients (40–75 years) classified as moderate/high risk had carotid plaque. χUnderestimated CVR in RA patients. χ∼Performed better in SLE if all items multiplied by 2
Despite evidence of progress achieved in identifying CVR biomarkers in young patients with ARDs, there are currently no validated CVR stratification tools recommended for use in these patients, and an unmet patient need to identify and manage CVR earlier in life
Summary
Chronic inflammation associated with autoimmune rheumatic disease (ARD) drives an increased risk for accelerated atherosclerosis in patients of all ages. The research is less advanced than in adult populations, it is recognized that young people with ARDs with childhood-onset have increased CVR compared to age-matched healthy controls, as supported by studies investigating lipid biomarker profile and markers of endothelial dysfunction. Further research is needed to address the unmet need for adequate CVR identification and management strategies in young people in general, and in those with underlying chronic inflammation in particular. This perspective paper explores various challenges in adequately identifying and managing CVR in younger populations and potential directions for future research
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