Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla (M.J.W.).
Section on Cardiovascular Medicine, Center for Prevention of Cardiovascular Disease, Wake Forest University School of Medicine, Winston-Salem, NC (M.D.S.).
Arterioscler Thromb Vasc Biol. 2024 Dec;44(12):2396-2406. doi: 10.1161/ATVBAHA.124.319983. Epub 2024 Oct 31.
Individuals with autoimmune inflammatory diseases, such as systemic lupus erythematosus, rheumatoid arthritis, and psoriasis, are at increased risk for cardiovascular disease. While these diseases share common features of systemic inflammation, the impact of individual autoimmune inflammatory conditions on circulating lipids and lipoproteins varies by specific disease, disease activity, and the immune-suppressing medications used to treat these conditions. A common feature observed in many autoimmune inflammatory diseases is the development of a proatherogenic dyslipidemic state, characterized by dysfunctional HDLs (high-density lipoproteins) and increased oxidation of LDLs (low-density lipoproteins). Various disease-modifying antirheumatic drugs also have complex and variable effects on lipids, and it is critical to take this into consideration when evaluating lipid-related risk in individuals with immune-mediated inflammatory conditions. This review aims to critically evaluate the current understanding of the relationship between immune-mediated inflammatory diseases and dyslipidemia, the underlying mechanisms contributing to atherogenesis, and the impact of various pharmacotherapies on lipid profiles and cardiovascular risk. We also discuss the role of lipid-lowering therapies, particularly statins, in managing residual risk in this high-risk population and explore the potential of emerging therapies with complementary anti-inflammatory and lipid-lowering effects.
患有自身免疫性炎症性疾病（如系统性红斑狼疮、类风湿关节炎和银屑病）的个体患心血管疾病的风险增加。虽然这些疾病具有全身性炎症的共同特征，但个体自身免疫性炎症状况对循环脂质和脂蛋白的影响因具体疾病、疾病活动度以及用于治疗这些疾病的免疫抑制药物而有所不同。在许多自身免疫性炎症性疾病中观察到的一个共同特征是形成促动脉粥样硬化的血脂异常状态，其特征是 HDL（高密度脂蛋白）功能障碍和 LDL（低密度脂蛋白）氧化增加。各种疾病修饰抗风湿药物对脂质也有复杂且可变的影响，在评估免疫介导的炎症性疾病个体的脂质相关风险时，必须考虑到这一点。这篇综述旨在批判性地评估免疫介导的炎症性疾病与血脂异常之间的关系、导致动脉粥样硬化形成的潜在机制，以及各种药物治疗对血脂谱和心血管风险的影响。我们还讨论了降脂治疗，特别是他汀类药物，在管理这一高风险人群的残余风险中的作用，并探讨了具有互补抗炎和降脂作用的新兴疗法的潜力。
