Antiphospholipid antibodies and atherosclerotic vascular disease: recent advances.

Growing evidence indicates that antiphospholipid antibodies (aPL) and antiphospholipid syndrome (APS) are not only associated with arterial thrombosis, but also enhanced premature atherosclerosis and stenotic lesions in various vascular beds. Atherosclerotic vascular disease involving coronary, carotid, and peripheral arteries is accelerated in APS to a larger extent when systemic lupus erythematosus (SLE) or other autoimmune disorders co-exist. However, the presence of aPL by itself may enhance atherosclerosis and increase the risk of arterial thromboembolic events also in older patients who did not meet the APS classification criteria. Traditional cardiovascular risk factors in particular hypertension and hypercholesterolemia largely contribute to the development and progression of cardiovascular disease and the occurrence of its thrombotic manifestations also in patients with aPL, therefore they should be vigorously treated like in patients free of autoimmune disorders. Nevertheless, antiplatelet agents alone and in combination with vitamin K antagonists (VKAs) remain a mainstay in prevention of arterial thrombosis in APS, despite controversy around the impact of typical atherosclerotic vascular disease and its risk factors on therapeutic strategies in the presence of IgG and/or IgM aPL at significant titers. The present overview summarizes clinical evidence for the role of aPL in subclinical and clinically overt atherosclerotic vascular disease and its management.