Читать книгу Blood and Marrow Transplantation Long Term Management - Группа авторов - Страница 154

Cardiovascular disease is caused by disorders of blood vessels and is closely related to atherosclerosis. Atherosclerosis is now considered an inflammatory process, where endothelial lesions occur decades before clinical manifestations such as stroke, coronary heart disease or peripheral arterial disease become manifest. Based on such concepts, cardiovascular disease might be expected decades after an endothelial damage occurs. Risk factors for arteriosclerosis in the general population are well established, and include smoking, arterial hypertension, obesity, diabetes, dyslipidaemias and physical inactivity. After HSCT, endothelial damage is induced by the conditioning regimen, and endothelial cells have been documented as a target of GVHD. In addition, a higher incidence and degree of cardiovascular risk factors might be the result of post‐transplant endocrine dysfunction, prolonged treatment with immunosuppressive drugs, or sedentary lifestyle. The increased incidence of cardiovascular events after allogeneic HCT supports the hypothesis that GVHD could be involved in the process. This is in line with the data on rarefaction of micro vessels in patients with cGVHD. This loss of micro vessels in the skin in cGVHD takes place independently of the epidermal injury. Patients with cGVHD have a significantly lower micro vessel density in the subcutaneous compartment, as compared to healthy controls. The correlation between GVHD and endothelial injury is also suggested in a study where donor‐derived cells contributed to the endothelial repair of GVHD‐induced lesions. Endothelial injury, due to a persistent vascular inflammation and endothelial cell death provoked by GVHD could therefore be responsible for atherosclerosis, and lead to premature cardiovascular accidents in long‐term survivors after allogeneic HSCT. Because of the long latency between an initial vascular injury and the appearance of a cardiovascular event, symptomatic cardiovascular disease might appear only decades after transplantation.