Cardiovascular Manifestations of Rheumatologic Diseases

T he prevalence and importance of cardiovascular disease in rheumatologic disorders have increased in the setting of therapeutic advances, resulting in longer life expectancy, a growing understanding of the importance of inflammation and the immune system in the initiation and progression of atherosclerosis, and enhanced disease detection with the use of sophisticated noninvasive cardiac and vascular diagnostic technology. This article will briefly review cardiovascular manifestations of rheumatologic diseases with an emphasis on recent clinical research. Rheumatologic diseases will be discussed individually for ease of reference, although pathophysiology and basis for cardiovascular abnormalities may be common among some of them. When applicable, cardiovascular disease will be categorized as vascular (accelerated atherosclerosis, arterial stiffness, small-vessel disease, aortic disease), myocardial (abnormalities of structure and function), valvular, pericardial, and conduction diseases. Endothelial dysfunction, although reported in some rheumatologic diseases, will not be systematically discussed in view of space limitations and the nonspecific and incompletely characterized nature of this abnormality. Discussion of suggested mechanisms underlying cardiovascular manifestations of rheumatologic diseases is beyond the scope of this review. Rheumatologic diseases with vasculitis as the primary manifestation, such as giant cell arteritis and Takayasu's arteritis, will not be discussed.