Rheumatoid Arthritis Patients at Increased Risk for Cardiovascular Death

In addition to recent research that used genetic factors to predict the severity of rheumatoid arthritis (RA), another development suggests that patients have an increased risk of a surprise heart attack even without showing symptoms.

With approximately 1.5 million Americans living with the condition, identifying additional problems within RA is crucial. Adriana Puente, a cardiologist in the National Medical Centre in Mexico, and her colleagues presented the study at the International Conference on Nuclear Cardiology and Cardiac CT (ICNC) in Madrid, Spain.

“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,” Puente said in a news release.

The team studied 91 RA patients, made up of 90% women with an average age of 59, who did not exhibit any symptoms of heart disease. They measured “the presence of ischemia and infarction secondary to atherosclerotic disease (coronary artery disease)” using the nuclear cardiology tool Gated Single Photon Emission Computed Tomography (SPECT). Inflammatory markers and RA activity were marked down for each subject as well.

The findings revealed that 24% of the patients, despite showing no symptoms, had abnormal Gated SPECT results which verifies ischemia or infarction.

“This means they are at increased risk of cardiovascular death,” Puente warned.

The test determined that some patients had other conditions as well including dyslipidemia (55%), hypertension (32%), smokers (14%), and type 2 diabetes (10%). The authors noted that there did not appear to be a connection between ischemia or infarction and RA activity, inflammatory, or cardiovascular variants. However, this could be contributed to the fact that the patients are on medication for the disease.

“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 (ischemia or myocardial infarction) even if they have no symptoms and regardless of whether they have cardiovascular risk factors,” Puente informed. “This is essential to prevent and reduce cardiovascular mortality.”

Since the RA drugs corticosteroids and methotrexate can cause elevated lipid levels and hyperhomocysteinemia, both cardiovascular risks, patients need to undergo preventative treatment.

“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,” Puente said. “They also need advice on how best to control their rheumatoid arthritis and decrease their cardiovascular risk factors.”