Cardiovascular events and the role of accelerated atherosclerosis in systemic vasculitis

The spectrum of inflammatory blood vessel diseases includes both atherosclerosis and the primary systemic vasculitides. Although the inciting triggers differ, significant overlap exists in the mechanisms that contribute to sustained inflammation and vascular damage in both entities. With improvement in therapeutics to control acute vasculitis leading to longer survival, cardiovascular morbidity and mortality has emerged as the leading cause of death for vasculitis patients. Cardiovascular events likely occur as a consequence of vasculitis, vascular damage from prior inflammation causing a sustained procoagulant state, and accelerated atherosclerosis. In this review, we discuss the latest evidence regarding risk of cardiovascular events in patients with major forms of primary systemic vasculitis, and review the mechanisms by which accelerated atherosclerosis may occur. [Display omitted] •Patients with systemic vasculitis are at significantly increased risk of cardiovascular (CV) events.•CV events may occur due to active vasculitis, a persistent procoagulant state, and/or accelerated atherosclerosis.•Numerous shared mechanisms underlie the pathogenesis of vasculitis and atherosclerosis.•Early vasculitis treatment, control of systemic inflammation and traditional CV risk management are needed to improve outcomes.