Atherosclerosis is a complex, multifactorial process that begins in childhood but becomes clinically evident later in life. Accumulating evidence suggests that atherosclerosis should be considered as a process mediated by the immune system that affects the vascular system. Besides, many experimental studies have shown that atherosclerotic plaques are composed of different immune cells like lymphocytes and macrophages.1

Autoimmune rheumatic diseases (AIRDs) are linked to increased rates of cardiovascular morbidity and mortality, primarily due to the expedited progression of atherosclerosis.2 This phenomenon can be attributed to traditional cardiovascular risk factors (CVRFs) associated with atherosclerosis, and the use of immunosuppressant drugs, but may also arise from the upregulation of other autoimmune and inflammatory mechanisms commonly described in AIRDs.2 Numerous AIRDs are associated with a higher prevalence of evident cardiovascular disease (CVD) and indications of advanced subclinical atherosclerosis, which can precede the onset of clinical manifestations. Consequently, early screening and preventive measures might be necessary.

According to the current guidelines, the recommendations regarding the atherosclerosis prevention in patients with AIRDs, such as rheumatoid arthritis (RA), systemic sclerosis (SSc), systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), Sjögren's syndrome (SS), and systemic vasculitides (SVs) do not differ significantly from those applied to the general population.3,4 The aim of the present study is to review the risk of accelerated atherosclerosis in AIRDs and to provide a summary of the available recommendations for the management of cardiovascular risk in rheumatic diseases.