Evidence of Systemic Inflammation and Estimation of Coronary Artery Disease Risk: A Population Perspective

A growing body of evidence indicates that patients with immune-inflammatory diseases experience an increased risk for cardiovascular morbidity and mortality. However, patients with immune-inflammatory diseases do not exhibit a corresponding increase in traditional coronary artery disease (CAD) risk factors that could explain the observed increase in CAD. Chronic inflammation is now accepted as playing a potentially important role in the promotion of atherosclerosis, a main cause of CAD. Evidence is also accumulating to suggest that the chronic systemic inflammation associated with immune-inflammatory diseases results in elevated levels of nontraditional CAD risk factors, such as biomarkers of inflammation, in patients with these conditions. Evaluation of only traditional CAD risk factors in these patients, therefore, may result in the underestimation of their future overall CAD risk. Using the Framingham patient cohort, we found associations between markers of inflammation and CAD risk overall. The contribution of inflammatory biomarkers should be considered along with the status of traditional CAD risk factors to gain a complete picture of the CAD risk in patients with underlying conditions that increase inflammation such as rheumatoid arthritis or systemic lupus erythematosus.