Endothelial function in patients with rheumatologic diseases

Abstract

Background. Сardiovascular diseases and their complications occupy one of the leading positions among causes of death in patients with rheumatologic diseases (RD), though the precise underlying mechanisms explaining fast progression of cardiovascular diseases are unknown. Early onset and high progression rate of atherosclerosis are the most common features, which cannot be fully explained by traditional cardiovascular risk factors. Inflammation, which is present in all RD and is involved in the pathogenesis of atherosclerosis, may contribute to the development of cardiovascular complications. Evaluation of the association between inflammation and endothelial dysfunction (an early predictor of atherosclerosis) may facilitate the understanding this mechanism. The objective of our study was to assess endothelial function in patients with systemic lupus erythematosus (SLE), systemic sclerosis (SSc), ankylosing spondylitis (AS) and rheumatoid arthritis (RA) and to evaluate the significance of various markers of endothelial dysfunction (ED), depending on the type of RD. Design and methods. The study enrolled 213 patients with various RD, 63 patients with ≥ 2 cardiovascular risk factors without RD and 10 healthy volunteers. Markers of endothelial dysfunction — homocysteine, asymmetric dimethylarginine (ADMA), endothelin 1–21, vascular cell adhesion molecule 1, 1sVCAM-1; intercellular adhesion molecule 1, sICAM-1 — and reactive hyperemia index (EndoPat 2000, Itamar Medical) were assessed in all patients. Results. The profile of ED markers differs in various RD, however, the most universal indicator is the ADMA level, especially in autoimmune RD with circulating autoantibodies (SLE, RA, SSc).