Patients with rheumatoid arthritis (RA) may be at increased risk of a surprise heart attack, according to new research presented on Monday at ICNC12, the International Conference on Nuclear Cardiology and Cardiac CT.
Dr. Adriana Puente, a cardiologist with the National Medical Centre in Mexico City, cited the results of a study which found that the risk was increased even when patients had no symptoms and was independent of traditional cardiovascular risk factors such as smoking and diabetes.
The study suggests that one quarter of patients with rheumatoid arthritis and no symptoms of heart disease do have coronary heart disease and could have a heart attack without prior warning, Dr. Puente said.
Researchers investigated the presence of ischaemia and infarction secondary to atherosclerotic disease (coronary artery disease) in 91 patients with rheumatoid arthritis and traditional cardiovascular risk factors but no symptoms of heart disease.
Inflammatory markers, rheumatoid arthritis disease activity and risk factors were measured in all patients, and the nuclear cardiology method Gated Single Photon Emission Computed Tomography (SPECT) was used to assess the existence of ischaemia and infarction, the European Association of Cardiovascular Imaging reported.
Results showed that 55% of patients had dyslipidemia (high blood lipids), 32% had hypertension, 14% were smokers and 10% had type 2 diabetes. Nearly one quarter (24%) of patients had abnormal Gated SPECT, indicating ischaemia or infarction. There was no significant correlation between the presence of ischaemia or infarction and rheumatoid arthritis disease activity, inflammatory markers or cardiovascular risk factors.
“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,” Dr. Puente said.
The cardiologist went on to recommend that patients with rheumatoid arthritis be told that they have a greater risk of developing heart disease and need 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,” Dr. Puente concluded.