At the recently concluded ICNC 12 held May 3-5, 2015 in Madrid, Spain, a study examining the risk of heart disease in patients with rheumatoid arthritis was presented by Dr. Adriana Puente. ICNC is organized by the Nuclear Cardiology and Cardiac CT section of the European Association of Cardiovascular Imaging (EACVI), a registered branch of the European Society of Cardiology (ESC), the American Society of Nuclear Cardiology (ASNC), and the European Association of Nuclear Medicine (EANM).
Around 90% of the study population were women who were 59 years old on average and had a similar frequency of cardiovascular risk factors as the general population. The main technique used in this study was a nuclear cardiology method called Gated Single Photon Emission Computed Tomography (SPECT). It tested the presence of ischaemia and myocardial infarction secondary to coronary artery disease in 91 patients with rheumatoid arthritis and traditional cardiovascular risk factors but no symptoms of heart disease. The results from this study showed that 55% of patients had dyslipidemia (high blood lipids), 32% had hypertension, 14% were smokers and 10% had type2 diabetes. Nearly one quarter (24%) of patients had abnormal Gated SPECT, indicating ischaemia or infarction.
It was observed that the patients with rheumatoid arthritis who had no inflammatory (rheumatoid disease related) activity or cardiovascular risk factors also had increased risks of heart attacks.
Commenting on the study, Dr. Puente said, “Rheumatoid arthritis affects 1.6% of the general population and is the first cause of consultation in the rheumatology service. The condition nearly doubles the risk of a heart attack but most patients never knew they had heart disease and were never alerted about their cardiovascular risk.”
To this, she added, “Our study shows that one quarter of patients with rheumatoid arthritis and no symptoms of heart disease do have coronary heart disease, as evidenced by the presence of myocardial ischaemia or infarction in the Gated SPECT study. This means they are at increased risk of cardiovascular death. The ischaemia and infarction may be explained by the persistence of the systemic inflammation in rheumatoid arthritis which may cause an accelerated atherosclerosis process. Our finding of no association between the Gated SPECT results and inflammatory markers could be because all the patients were taking pharmacological treatment.”
Commenting on the implications of this study, Dr. Puente noted, “The results highlight the importance of conducting diagnostic tests in patients with rheumatoid arthritis to see if they have cardiovascular disease, specifically atherosclerotic coronary artery disease (ischaemia or myocardial infarction) even if they have no symptoms and regardless of whether they have cardiovascular risk factors. This is essential to prevent and reduce cardiovascular mortality.”
Dr. Puente’s advice to patients with rheumatoid arthritis: “Patients with rheumatoid arthritis should be told that they have an elevated predisposition to heart disease and need pharmacological treatment to diminish the inflammatory process and atherosclerotic complications. They also need advice on how best to control their rheumatoid arthritis and decrease their cardiovascular risk factors. Patients who take corticosteroids and methotrexate for their rheumatoid arthritis are susceptible to elevated plasma lipid levels and develop hyperhomocysteinemia, respectively, which are both cardiovascular risk factors and require preventative treatment.”
