Rischio cardiovascolare nei pazienti affetti da malattie infiammatorie croniche: valutazione della relazione tra meccanismi immunologici, profilo metabolico e stile di vita

Cardiovascular disease (CVD) is the most frequent cause of death worldwide and well established, traditional risk factors for CVD comprise age, sex, race, hypertension, diabetes, smoking, and hyperlipidaemia, all of which are included in various prediction models. However, over the past 20 years several non-traditional risk factors, such as chronic inflammation, have emerged as amplifiers of CV risk. This notion opened a new scenario putting forward the hypothesis that individuals with chronic inflammatory diseases may display a higher CV risk that could not be explained in full by traditional CV risk factors. The majority of data regarding CV risk and CV diseases in rheumatoid arthritis (RA) and spondyloartritis (SpA) are mainly derived from studies in patients with established disease while data in early phases are less. On this basis the aims of our study were: i. to assess the CV burden, in patients with RA and SpA at the time of disease diagnosis; ii. to explore the burden of metabolic-associated fatty liver disease (MASLD) in patients with RA and SpA at the time of disease diagnosis; iii. to identify possible associations between the CV scenario and disease specific variables. To achieve these aims, we designed a study including a retrospective part exploring the full RA e SpA cohort referring at our Center and a cross-sectional part assessing newly diagnosed patients. Our study demonstrated that while patients with RA seem to develop a cumulative CV burden from the disease onset and during the disease course, patients with SpA already display a consistent CV history with CV events occurring years before SpA diagnosis. Furthermore, we identified differences related to gender within the different diseases accounting for a different risk of CV events. Finally, by assessing arterial characteristics and function in patients at the time of SpA or RA diagnosis, it emerged that while arterial stiffness seems within the normal range, endothelial impairment is already present compared to normal individuals. In conclusion, CV risk assessment in patients with RA and SpA should be thoroughly performed from the time of disease diagnosis and using not only a clinical assessment but also investigational procedures to investigate arterial stiffness and subclinical atherosclerosis.