cardiovascular-agents and Systemic-Vasculitis

Epidemiologic data support the association of psoriasis and psoriatic arthritis with adverse cardiovascular outcomes. Shared pathogenesis in endothelial dysfunction may underlie psoriasis and atherosclerosis. Tumor necrosis factor (TNF) inhibitors may modulate endothelial dysfunction seen in patients with psoriasis and psoriatic arthritis.. To perform a systematic review that investigated endothelial function in psoriasis and psoriatic arthritis and the effect of TNF inhibitors on endothelial function in psoriasis and psoriatic arthritis.. MEDLINE (1980-October 2012), Web of Science, the EULAR abstract database, and the AAD annual meeting abstract archive were searched for cross-sectional or longitudinal studies that 1) examined endothelial function in patients with psoriasis or psoriatic arthritis, or 2) investigated the effect of TNF inhibitor therapy on endothelial function.. Twenty articles and four abstracts with 2261 patients evaluated endothelial function in psoriasis and psoriatic arthritis, which was measured by pulse wave velocity, flow-mediated dilation, nitroglycerine-induced vasodilation, carotid intima-media thickness, peripheral arterial tonometry, or aortic stiffness parameters. The majority of the data suggests that patients with psoriasis and psoriatic arthritis have significantly increased arterial stiffness, impaired endothelial-dependent vasodilation, increased carotid intima-media thickness, and decreased aortic elasticity compared to the general population. Two out of three studies showed that TNF inhibitors improved endothelial function in psoriasis and psoriatic arthritis.. Measurements of endothelial function were not standardized across studies.. The preponderance of literature suggests that endothelial function is significantly impaired in patients with psoriasis and psoriatic arthritis compared to the general population. Preliminary evidence suggests that TNF inhibitors may improve endothelial function in the psoriasis and psoriatic arthritis populations.

Topics: Adalimumab; Animals; Anti-Inflammatory Agents, Non-Steroidal; Antibodies, Monoclonal; Antibodies, Monoclonal, Humanized; Antirheumatic Agents; Arthritis, Psoriatic; Cardiovascular Agents; Cardiovascular Diseases; Endothelium, Vascular; Etanercept; Evidence-Based Medicine; Humans; Immunoglobulin G; Infliximab; Psoriasis; Receptors, Tumor Necrosis Factor; Risk Factors; Systemic Vasculitis; Tumor Necrosis Factor-alpha

Leptin has received much attention since its cloning in 1994. Initially, leptin research centered on satiety, energy balance and sympathetic activation. However, hyperleptinemia has since been identified as an independent risk factor for various cardiovascular pathologies including atherosclerotic coronary artery disease. Over the last decade, multiple studies have implicated leptin as an important mediator in endothelial dysfunction and neointimal hyperplasia, both key steps in the evolution of atherosclerotic vascular changes. Additionally, more recent evidence indicates that paracrine leptin release from perivascular adipose tissue (PVAT) has deleterious effects on the underlying endothelium and vascular smooth muscle cells (SMC), including the coronary circulation. This report reviews pertinent literature on leptin-mediated endothelial dysfunction, SMC proliferation and the role of PVAT-derived leptin with an emphasis on the coronary circulation and discussions of currently proposed molecular mechanisms of PVAT-mediated coronary endothelial dysfunction and neointimal hyperplasia.

Topics: Adipose Tissue; Animals; Atherosclerosis; Cardiovascular Agents; Down-Regulation; Endothelium, Vascular; Humans; Hyperplasia; Leptin; Models, Cardiovascular; Molecular Targeted Therapy; Systemic Vasculitis; Tunica Intima; Up-Regulation

Cardiovascular manifestations in systemic vasculitis include initially silent cardiomyopathy due to either ischemic or inflammatory causes. The combination of vasculitis and cardiomyopathy is associated with a poor prognosis. Early treatment with immunosuppressants in conjunction with appropriate cardiac pharmacotherapy is considered important and has dramatically improved prognosis. Cardiovascular magnetic resonance, due to its nonionizing, noninvasive evaluation of the cardiovascular system, can be of great value in the diagnosis, follow-up, and treatment of patients with systemic vasculitis.

Topics: Cardiovascular Agents; Early Diagnosis; Heart Failure; Humans; Immunosuppressive Agents; Magnetic Resonance Imaging; Predictive Value of Tests; Prognosis; Risk Factors; Systemic Vasculitis

Topics: Anti-Inflammatory Agents; Autoimmune Diseases; Autoimmunity; Cardiovascular Agents; Cardiovascular Diseases; Drug Design; Humans; Immunomodulation; Molecular Targeted Therapy; Rheumatic Diseases; Rheumatoid Vasculitis; Systemic Vasculitis

Topics: Adult; Cardiovascular Agents; Female; Giant Cell Arteritis; Humans; Immunosuppressive Agents; Male; Polyarteritis Nodosa; Syndrome; Systemic Vasculitis; Takayasu Arteritis; Thromboangiitis Obliterans; Vasculitis