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Researchers shed light on the link between
chronic inflammation and atherosclerosis
Rheumatoid arthritis, lupus, and other
inflammatory rheumatic diseases are associated with a high rate of
death from heart disease.
One explanation is a greater
susceptibility to atherosclerosis. Although atherosclerosis is linked
to inflammation in healthy individuals as well, the mechanism of
inflammation and the reason for accelerated atherosclerosis in patients
with inflammatory rheumatic disease remain unclear. Does
atherosclerosis result from systemic inflammation, a hallmark of these
rheumatic diseases, or from local inflammation of vessels?
To shed light on the link between chronic
inflammation and atherosclerosis, a team of researchers in Norway and
the United States, affiliated with the Cleveland Clinic Foundation and
Brigham and Women's Hospital in Boston, focused on the aortas of recent
recipients of coronary artery bypass graft (CABG) surgery, comparing
biopsy specimens from patients with inflammatory rheumatic disease to
those from patients without it. Their study, presented in the June 2007
issue of Arthritis & Rheumatism
inflammatory rheumatic disease and smoking as independent predictors of
vessel wall inflammation. The vascular inflammation might be a factor
that promotes atherosclerosis and the formation of aneurysms.
samples were obtained during CABG surgery, performed at two cardiac
centers in Norway, from 66 patients with inflammatory rheumatic disease
and 51 control patients. The inflammatory rheumatic disease group
included patients with rheumatoid arthritis, psoriatic arthritis,
lupus, ankylosing spondylitis, polymyalgia and other diseases. Age,
body mass index, family history of heart disease, and other traditional
cardiovascular risk factors were similar in both groups. All specimens
were evaluated, by light microscope, for evidence of chronic
inflammatory cell infiltration in the aortic wall. This was achieved by
counting and measuring the mononuclear cell infiltrates (MCI) in the
aorta, with particular attention to the adventitia, the deepest layer
of vascular tissue. Using statistical analysis, the relationship
between these inflammatory infiltrates and established lifestyle risk
factors for heart disease was also assessed.
In the adventitia, MCIs occurred more
frequently in patients with inflammatory rheumatic disease -- 47
percent of this group, compared with 20 percent of the control group.
Along with greater prevalence, these inflammatory cells were larger in
size. In the middle layer of the vessel wall (the media), MCIs were
detected only in patients with inflammatory rheumatic disease. What's
more, MCIs were observed in 6 of 7 patients with a history of aortic
aneurysm. In addition to inflammatory rheumatic disease, current
smoking was independently associated with more pronounced chronic
inflammatory infiltration in the inner adventitia.
"The opportunities for detecting aortic
inflammation are limited," acknowledges the study's spokesperson, Ivana
Hollan, M.D. "Our method of tissue examination allows the condition to
be diagnosed in patients undergoing CABG surgery without increasing the
Despite the limitations of its small
sample size, this groundbreaking study of aortic inflammation in
patients with inflammatory rheumatic disease indicates the need for
further investigation into an inflammatory process that may increase
vulnerability to dying from a heart attack or aneurysm.
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