Rheumatoid arthritis ups risk of no-warning heart attack

by Bruce Sylvester: Rheumatoid arthritis is associated with an increased risk of no-warning heart attack, researchers reported on May 4, 2015 at ICNC 12 (International Conference on Nuclear Cardiology and Cardiac CT) in Madrid, Spain.

“Our study suggests that one quarter of patients with rheumatoid arthritis and no symptoms of heart disease could have a heart attack without prior warning,” said investigator  Adriana Puente, M.D., a cardiologist in the National Medical Centre “20 de Noviembre” ISSSTE in Mexico City, Mexico. “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,” she added

The investigators studied 91 subjects with rheumatoid arthritis and traditional cardiovascular risk factors, but with no symptoms of heart disease. Subjects were 90% female, an average of 59 years old and showed a similar cardiovascular risk profile as the general population

They measured  traditional risk factors  fro coronary heart disease and reported that 55% of the subjects had dyslipidemia, 32% had hypertension, 14% were smokers and 10% had type 2 diabetes.

The investigators evaluated for ischaemia and infarction using the nuclear cardiology method Gated Single Photon Emission Computed Tomography (SPECT). Notably, 24% of patients had abnormal Gated SPECT, indicating ischaemia or infarction, but without showing other symptoms of. coronary heart disease.

Puente said, “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.”

She emphasized that that the presence of ischaemia or infarction was independent of cardiovascular risk factors.

Puente concluded, “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.”

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).