Cardiac involvement in primary systemic vasculitis and potential drug therapies to reduce cardiovascular risk

Durga Prasanna Misra, Sajjan N. Shenoy

Research output: Contribution to journalReview article

16 Citations (Scopus)

Abstract

Cardiac involvement is common in primary systemic vasculitides and may be due to direct effect of the disease on the heart or due to therapy. We shall review involvement of the heart in the various forms of primary systemic vasculitis. Among anti-neutrophil cytoplasmic antibody-associated vasculitis (AAV), eosinophilic granulomatosis with polyangiitis most commonly involves the heart. Involvement of the heart confers poorer prognosis in AAV, which is also complicated by increased risk of cardiovascular events. Kawasaki’s disease (KD) is the most common form of medium-vessel vasculitis to affect the heart, with coronary artery aneurysms being the most common manifestation. These predispose patients with KD to develop premature ischemic heart disease. Takayasu’s arteritis is the most common large-vessel vasculitis to involve the heart and can result in aortic incompetence, myocarditis, or coronary heart disease. Involvement of the heart in Behcet’s disease is usually in the form of intracardiac mass lesions, thrombosis, or endomyocardial fibrosis. Drugs used in the treatment of systemic vasculitis influence the risk of developing cardiovascular events. Corticosteroid therapy has been shown to increase the risk of myocardial infarction, whereas methotrexate, azathioprine, mycophenolate mofetil, rituximab, and anti-tumor necrosis alpha agents favorably modulate the risk of cardiovascular events, predominantly by dampening systemic inflammation. Awareness of cardiac involvement in vasculitis and accelerated cardiovascular risk in these patients should help clinicians to maximize the modulation of modifiable risk factors for heart disease in these individuals.

Original languageEnglish
Pages (from-to)151-167
Number of pages17
JournalRheumatology International
Volume37
Issue number1
DOIs
Publication statusPublished - 01-01-2017
Externally publishedYes

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Systemic Vasculitis
Vasculitis
Drug Therapy
Heart Diseases
Endomyocardial Fibrosis
Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis
Mycophenolic Acid
Coronary Aneurysm
Takayasu Arteritis
Granulomatosis with Polyangiitis
Aortic Valve Insufficiency
Behcet Syndrome
Myocarditis
Azathioprine
Methotrexate
Myocardial Ischemia
Coronary Disease
Coronary Vessels
Adrenal Cortex Hormones
Thrombosis

All Science Journal Classification (ASJC) codes

  • Rheumatology
  • Immunology and Allergy
  • Immunology

Cite this

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Cardiac involvement in primary systemic vasculitis and potential drug therapies to reduce cardiovascular risk. / Misra, Durga Prasanna; Shenoy, Sajjan N.

In: Rheumatology International, Vol. 37, No. 1, 01.01.2017, p. 151-167.

Research output: Contribution to journalReview article

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