Immune-mediated inflammatory diseases (IMIDs) are recognised risk factors for accelerated atherosclerotic cardiovascular disease (CVD), particularly in younger individuals and women who lack traditional CVD risk factors. Reflective of the critical role that inflammation plays in the formation, progression and rupture of atherosclerotic plaques, research into immune mechanisms of CVD has led to the identification of a range of therapeutic targets that are the subject of ongoing clinical trials. Several key inflammatory pathways implicated in the pathogenesis of atherosclerosis are targeted in people with IMIDs. However, cardiovascular risk continues to be systematically underestimated by conventional risk assessment tools in the IMID population, resulting in considerable excess CVD burden and mortality. Hence, there is a pressing need to improve methods for CVD risk-stratification among patients with IMIDs, to better guide the use of statins and other prognostic interventions. CT coronary angiography (CTCA) is the current first-line investigation for diagnosing and assessing the severity of coronary atherosclerosis in many individuals with suspected angina. Whether CTCA is also useful in the general population for reclassifying asymptomatic individuals and improving long-term prognosis remains unknown. However, in the context of IMIDs, it is conceivable that the information provided by CTCA, including state-of-the-art assessments of coronary plaque, could be an important clinical adjunct in this high-risk patient population. This narrative review discusses the current literature about the use of coronary CT for CVD risk-stratification in three of the most common IMIDs including rheumatoid arthritis, psoriasis and systemic lupus erythematosus.

中文翻译：

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使用冠状动脉计算机断层扫描评估免疫介导的炎症性疾病的心血管风险

免疫介导的炎症性疾病 (IMID) 被认为是加速动脉粥样硬化性心血管疾病 (CVD) 的危险因素，特别是在缺乏传统 CVD 危险因素的年轻人和女性中。对CVD免疫机制的研究反映了炎症在动脉粥样硬化斑块的形成、进展和破裂中发挥的关键作用，从而确定了一系列治疗靶点，这些靶点是正在进行的临床试验的主题。 IMID 患者的目标是与动脉粥样硬化发病机制有关的几个关键炎症途径。然而，传统风险评估工具仍然系统性地低估了 IMID 人群的心血管风险，导致 CVD 负担和死亡率显着过高。因此，迫切需要改进 IMID 患者的 CVD 风险分层方法，以更好地指导他汀类药物和其他预后干预措施的使用。 CT 冠状动脉造影 (CTCA) 是目前诊断和评估许多疑似心绞痛患者冠状动脉粥样硬化严重程度的一线检查。 CTCA 是否也可用于普通人群对无症状个体的重新分类和改善长期预后仍不清楚。然而，在 IMID 的背景下，可以想象 CTCA 提供的信息（包括最先进的冠状动脉斑块评估）可能成为这一高危患者群体的重要临床辅助手段。这篇叙述性综述讨论了关于使用冠状动脉 CT 对三种最常见的 IMID 进行 CVD 风险分层的当前文献，包括类风湿关节炎、银屑病和系统性红斑狼疮。