Fig. 2.

Peripheral activation of the adaptive immune system confers increased risk for cardiovascular disease. Several autoimmune diseases with major pathological manifestations external to the vascular system confer independent elevated risk for accelerated atherosclerosis and cardiovascular disease (CVD). These include autoimmune psoriasis, rheumatoid arthritis, systemic lupus erythematous, and irritable bowel disease (Crohn’s and ulcerative colitis). While the inciting antigen is not known for each disease, suggested antigens that may contribute to systemic autoreactivity are noted in boxes. In addition to autoimmune disease, certain viral infections with chronic latency [cytomegalovirus (CMG), hepatitis C virus (HCV), and human immunodeficiency virus (HCV)] also confer increased risk for CVD complications, especially in the setting of cardiac and vessel transplants. These infections generate long-lasting pools of memory T cells that reside in barrier tissues and secondary lymphoid organs and, possibly, the vessel wall and are susceptible to inflammatory reactivation.