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Sanghavi N, Ingrassia JP, Korem S, Ash J, Pan S, Wasserman A. Cardiovascular Manifestations in Rheumatoid Arthritis. Cardiol Rev 2024; 32:146-152. [PMID: 36729119 DOI: 10.1097/crd.0000000000000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disorder that characteristically affects the joints. RA has extra-articular manifestations that can impact multiple organ systems including the heart, lungs, eyes, skin, and brain. Cardiovascular involvement is a leading cause of mortality in RA. Cardiovascular manifestations of RA include accelerated atherosclerosis, heart failure, pericarditis, myocarditis, endocarditis, rheumatoid nodules, and amyloidosis. Inflammation is an important mediator of endothelial dysfunction and is a key driver of cardiovascular risk and complications in patients with RA. Prompt identification of cardiac pathologies in patients with RA is essential for appropriate management and treatment. Choosing the most appropriate treatment regimen is based on individual patient factors. In this article, we provide a comprehensive review of the epidemiology, pathophysiology, clinical manifestations, diagnosis, and medical management of cardiovascular manifestations of RA. We also discuss the relationship between anti-rheumatic medications, specifically non-steroidal anti-inflammatory drugs, corticosteroids, methotrexate, statins, tumor necrosis factor inhibitors, interleukin-6 inhibitors, Janus kinase inhibitors, and cardiovascular disease.
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Affiliation(s)
- Nirali Sanghavi
- From the Department of Medicine, Westchester Medical Center, Valhalla, NY
| | | | - Sindhuja Korem
- Department of Rheumatology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Julia Ash
- Department of Rheumatology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Amy Wasserman
- Department of Rheumatology, Westchester Medical Center/New York Medical College, Valhalla, NY
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Kim JH, Lee G, Hwang J, Kim J, Kwon J, Song Y. Performance of Cardiovascular Risk Prediction Models in Korean Patients With New-Onset Rheumatoid Arthritis: National Cohort Study. J Am Heart Assoc 2023; 12:e030604. [PMID: 37982210 PMCID: PMC10727304 DOI: 10.1161/jaha.123.030604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 10/19/2023] [Indexed: 11/21/2023]
Abstract
BACKGROUND This study aimed to compare the performance of established cardiovascular risk algorithms in Korean patients with new-onset rheumatoid arthritis. METHODS AND RESULTS This retrospective cohort study identified patients newly diagnosed with rheumatoid arthritis without a history of cardiovascular diseases between 2013 and 2019 using the National Health Insurance Service database. The cohort was followed up until 2020 for the development of the first major adverse cardiovascular event. General cardiovascular risk prediction algorithms, such as the systematic coronary risk evaluation model, the Korean risk prediction model for atherosclerotic cardiovascular diseases, the American College of Cardiology/American Heart Association pooled equations, and the Framingham Risk Score, were used. The discrimination and calibration of cardiovascular risk prediction models were evaluated. Hazard ratios were estimated using Cox proportional hazards regression. A total of 611 patients among 24 889 patients experienced a major adverse cardiovascular event during follow-up. The median 10-year atherosclerotic cardiovascular diseases risk score was significantly higher in patients with major adverse cardiovascular events than those without. The C-statistics of risk algorithms ranged between 0.72 and 0.74. Compared with the low-risk group, the actual risk of developing major adverse cardiovascular events increased significantly in the intermediate- and high-risk groups for all algorithms. However, the risk predictions calculated from all algorithms overestimated the observed cardiovascular risk in the middle to high deciles, and only the systematic coronary risk evaluation algorithm showed comparable observed and predicted event rates in the low-intermediate deciles with the highest sensitivity. CONCLUSIONS The systematic coronary risk evaluation model algorithm and the general risk prediction models discriminated patients with rheumatoid arthritis appropriately. However, overestimation should be considered when applying the cardiovascular risk prediction model in Korean patients.
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Affiliation(s)
- Jae Hyun Kim
- School of Pharmacy and Institute of New Drug DevelopmentJeonbuk National UniversityJeonjuRepublic of Korea
| | - Gaeun Lee
- Department of StatisticsDaegu UniversityGyeongbukRepublic of Korea
| | - Jinseub Hwang
- Department of StatisticsDaegu UniversityGyeongbukRepublic of Korea
| | - Ji‐Won Kim
- Division of Rheumatology, Department of Internal MedicineDaegu Catholic University School of MedicineDaeguRepublic of Korea
| | - Jin‐Won Kwon
- BK21 FOUR Community‐Based Intelligent Novel Drug Discovery Education Unit, College of Pharmacy and Research Institute of Pharmaceutical SciencesKyungpook National UniversityDaeguRepublic of Korea
| | - Yun‐Kyoung Song
- College of PharmacyDaegu Catholic UniversityGyeongbukRepublic of Korea
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Popescu D, Rezus E, Badescu MC, Dima N, Seritean Isac PN, Dragoi IT, Rezus C. Cardiovascular Risk Assessment in Rheumatoid Arthritis: Accelerated Atherosclerosis, New Biomarkers, and the Effects of Biological Therapy. Life (Basel) 2023; 13:life13020319. [PMID: 36836675 PMCID: PMC9965162 DOI: 10.3390/life13020319] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
Rheumatoid arthritis (RA), one of the most common of the chronic inflammatory autoimmune diseases (CIADs), is recognized as an independent cardiovascular risk factor. Traditional risk factors such as smoking, arterial hypertension, dyslipidemia, insulin resistance, and obesity are frequently found in RA. Given the increased risk of mortality and morbidity associated with cardiovascular disease (CVD) in RA patients, screening for risk factors is important. Moreover, there is a need to identify potential predictors of subclinical atherosclerosis. Recent studies have shown that markers such as serum homocysteine, asymmetric dimethylarginine, or carotid intima-media thickness (cIMT) are correlated with cardiovascular risk. Although RA presents a cardiovascular risk comparable to that of diabetes, it is not managed as well in terms of acute cardiovascular events. The introduction of biological therapy has opened new perspectives in the understanding of this pathology, confirming the involvement and importance of the inflammatory markers, cytokines, and the immune system. In addition to effects in inducing remission and slowing disease progression, most biologics have demonstrated efficacy in reducing the risk of major cardiovascular events. Some studies have also been conducted in patients without RA, with similar results. However, early detection of atherosclerosis and the use of targeted therapies are the cornerstone for reducing cardiovascular risk in RA patients.
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Affiliation(s)
- Diana Popescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- Internal Medicine Clinic, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Elena Rezus
- Department of Rheumatology and Physiotherapy, “Grigore. T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- Rheumatology Clinic, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
- Correspondence: (E.R.); (M.C.B.)
| | - Minerva Codruta Badescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- Internal Medicine Clinic, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
- Correspondence: (E.R.); (M.C.B.)
| | - Nicoleta Dima
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- Internal Medicine Clinic, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Petronela Nicoleta Seritean Isac
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- Internal Medicine Clinic, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Ioan-Teodor Dragoi
- Department of Rheumatology and Physiotherapy, “Grigore. T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- Rheumatology Clinic, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- Internal Medicine Clinic, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
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Kim HR, Kim SH. Perioperative and anesthetic management of patients with rheumatoid arthritis. Korean J Intern Med 2022; 37:732-739. [PMID: 35811362 PMCID: PMC9271718 DOI: 10.3904/kjim.2021.555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 04/03/2022] [Indexed: 11/27/2022] Open
Abstract
Our understanding and management of rheumatoid arthritis (RA) have greatly improved, but perioperative and anesthetic management remain challenging. RA is not limited to joints; systemic evaluation is thus required when planning perioperative management. Especially, careful airway evaluation is needed; management of airway-related arthritis is challenging. A multidisciplinary approach is essential to prevent complications without exacerbating RA disease activity. Guidelines published in 2017 are available for perioperative management of anti-rheumatic medication in patients with rheumatic diseases undergoing elective total hip or total knee arthroplasty. However, the guidelines focus only on anti- rheumatic medications, and do not consider all aspects of perioperative management (including anesthesia). Here, we discuss the perioperative and anesthetic management of patients with RA.
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Affiliation(s)
- Hae-Rim Kim
- Division of Rheumatology, Department of Internal Medicine, Research Institute of Medical Science, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul,
Korea
| | - Seong-Hyop Kim
- Department of Medicine, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, Seoul,
Korea
- Department of Anesthesiology and Pain Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul,
Korea
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Ahmed O, Krishnamurthy V, Kaba RA, Tahir H. The Management of Cardiovascular Disease Risk in Patients with Rheumatoid Arthritis. Expert Opin Pharmacother 2022; 23:947-958. [PMID: 35575484 DOI: 10.1080/14656566.2022.2076594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Rheumatoid Arthritis (RA) is a chronic inflammatory disorder associated with an increased incidence and prevalence of cardiovascular disease (CVD), including myocardial infarction and heart failure. In addition to traditional risk factors, evidence suggests inflammation is critical to the pathophysiology of both conditions. Despite the association being well-recognised, challenges remain in managing cardiovascular risk in RA. AREAS COVERED This manuscript analyses the association between CVD and RA andexplores the limitations in evaluating cardiovascular risk in RA with available risk assessment tools. The authors review and discuss the optimal management of traditional risk factors such as hypertension and dyslipidaemia and contemporary risk factors such as inflammation and analyse the cardiovascular impact of RA medications. EXPERT OPINION Analysis points to the critical role of inflammation in the pathogenesis of RA and CVD. It is well established that conventional disease-modifying anti-rheumatic drugs (DMARDs) improve cardiovascular outcomes; however, underlying risk often remains underappreciated. The authors suggest there remains an opportunity to improve mortality and morbidity with the early recognition and identification of at-risk populations and the timely initiation of appropriate cardiovascular and anti-inflammatory medications. More research is necessary into the role that imaging may play in stratifying risk and in the longer-term cardiovascular impact of biological DMARDs.
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Affiliation(s)
- Omar Ahmed
- Senior Research Fellow in Cardiology & Cardiac Electrophysiology, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, London, UK
| | - Vinodh Krishnamurthy
- Research Practitioner, Royal Free London NHS Trust, Barnet Hospital, Wellhouse Lane, Wellhouse Lane EN5 3DJ, UK
| | - Riyaz A Kaba
- Consultant in Cardiac Electrophysiology & Devices, St George's University Hospitals NHS Foundation Trust, Blackshaw Road, London, UK
| | - Hasan Tahir
- Consultant Physician & Rheumatologist, Honorary Clinical Professor, University College London, Royal Free London NHS Trust, Wellhouse Lane EN5 3DJ, UK
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Min HK, Kim HR, Lee SH, Kang KY, Park SH, Kwok SK. Time-averaged DAS28 and HAQ predict cardiovascular disease in patients with rheumatoid arthritis: data from KORONA registry. Joint Bone Spine 2022; 89:105401. [PMID: 35513231 DOI: 10.1016/j.jbspin.2022.105401] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 03/09/2022] [Accepted: 04/19/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the predictive role of time-averaged disease activity score (DAS)28 and Health Assessment Questionnaire (HAQ) on cardiovascular disease (CVD) events in patients with rheumatoid arthritis (RA). METHODS Patients with RA were recruited from 23 tertiary hospitals. Baseline and annual follow-up data of demographic, laboratory, questionnaire, RA-associated parameters, and occurrence of CVD were collected. Patients were divided into three groups according to time-averaged DAS28: 1) remission (<2.6), 2) low (2.6-3.2), 3) moderate (3.2-5.1), and 4) high (>5.1). Kaplan-Meier curves was performed to compare the cumulative probability of CVD. Hazard ratios of each factor on the occurrence of CVD were obtained using Cox regression analyses. RESULTS A total of 4,034 RA patients with 826 for remission, 938 for low, 2,002 for moderate, and 268 for high time-averaged DAS28 groups were included. Baseline age, disease duration, ESR, CRP, DAS28, and HAQ scores were higher in the high time-averaged DAS28 group. The incidence rate of CVD was 2.86, 2.71, 3.53, and 8.13 events per 1,000 person-years for the remission, low, moderate, and high time-averaged DAS28 groups, respectively. The incidence rate ratio of CVD in the high time-averaged DAS28 group were 3.01 (95% CI 1.20-8.50) when compared to low time-averaged DAS28 group. The cumulative hazard for CVD in the high time-averaged DAS28 group was significantly high (log-rank P<0.01). In multivariate Cox regression analysis, age, high time-averaged DAS28, and time-averaged HAQ>0.5, were positively associated with CVD events in RA patients. CONCLUSIONS In patients with RA, time-averaged DAS28 and HAQ could predict the occurrence of CVD. TRIAL REGISTRATION Clinical Research Information Service of South Korea https://cris.nih.go.kr: KCT0000086, registered May 26, 2009.
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Rueda-Gotor J, Ferraz-Amaro I, Genre F, González-Mazón I, Corrales A, Calvo-Rio V, Portilla V, Llorca J, Expósito R, Hernández-Hernández V, Quevedo-Abeledo JC, Rodríguez-Lozano C, Lopez-Medina C, Ladehesa-Pineda ML, Castañeda S, Vicente EF, Fernández-Carballido C, Martínez-Vidal MP, Castro-Corredor D, Anino-Fernández J, Peiteado D, Plasencia-Rodríguez C, García-Vivar ML, Galíndez-Agirregoikoa E, Montes-Perez E, Fernández-Díaz C, Blanco R, González-Gay MÁ. Factors associated with atherosclerosis in radiographic and non-radiographic axial spondyloarthritis. A multicenter study on 838 patients. Semin Arthritis Rheum 2022; 55:152037. [DOI: 10.1016/j.semarthrit.2022.152037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/01/2022] [Accepted: 05/24/2022] [Indexed: 12/24/2022]
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Husarchuk AG, Ilashchuk TO, Okipniak IV, Vasiuk VL, Mykytiuk OM, Mikulets LV, Stasyshena OV. PARAMETERS OF ENDOTHELIAL DYSFUNCTION AND IMMUNE RESPONSE IN PATIENTS WITH RHEUMATOID ARTHRITIS WITH AND WITHOUT ISCHEMIC HEART DISEASE. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:1985-1990. [PMID: 36129083 DOI: 10.36740/wlek202208208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim: To determine changes in endothelial dysfunction and immunological response in patients with rheumatoid arthritis with and without coronary heart disease. PATIENTS AND METHODS Materials and methods: The study involved 151 patients with RA and coronary heart disease. The ED was assessed by examining the NO system in RA for determination of the content in the blood of the product of NO synthase - the final metabolites of NO2- and NO3- and the level of VEGF and CD28 in the serum. RESULTS Results: The results of the study of the levels of metabolites NO2- and NO3- in the first and second groups showed their increased content. Analysis of the content of VEGF in the blood for patients with different durations of the disease showed that the concentration of the studied protein grows larger with increasing duration of the disease. The maximum of sCD28 concentration was found in middle-aged patients, and the minimum (the difference was significant) - in the elderly. CONCLUSION Conclusions: As the duration of the disease increases, the content of VEGF in the blood of patients increases, which, at the same time, did not show age dependence on RA and did not change further with concomitant coronary heart disease. Detected concentrations of sCD28 are higher in patients with less prolonged RA, and begin to decrease with increasing duration of the disease.
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