Cardiovascular Risk in RA Patients May Be As High as in Diabetes Patients

A study presented at the 2017 ACR/ARHP Annual Meeting found that coronary microvascular dysfunction is as prevalent among patients with rheumatoid arthritis (RA) as it is among patients with diabetes, suggesting a similar risk profile.

“Patients with diabetes have increased coronary microvascular dysfunction compared to the general population, leading to higher rates of cardiac death despite normal perfusion scans,” Katherine P Liao, of the division of rheumatology, immunology and allergy at Brigham and Women’s Hospital and Harvard Medical School, and colleagues wrote. “While coronary microvascular dysfunction is also thought to play a role in excess cardiovascular risk in RA, studies are limited. Coronary microvascular dysfunction can be detected using coronary flow reserve, calculated using data from clinically available stress myocardial perfusion PET scans. A pathognomonic sign of coronary microvascular dysfunction is a patient with normal perfusion on a stress test, but impaired coronary flow reserve.”

In order to determine the prevalence of coronary microvascular dysfunction among patients with RA compared to patients with diabetes, the researchers examined stress test results of 49 patients with RA and 163 patients with diabetes. According to the presentation, RA patients had a mean age of 64.4 years. The researchers noted that there were no significant differences in demographic data between the two study groups.

Dr Liao and colleagues found that the mean coronary flow reserve score was 2.02 among RA and diabetes patients with very similar distribution of scores between the two study groups. As a result, they also found that patients with low coronary flow reserve scores with RA had a similar all-cause mortality compared to patients with poor coronary flow who also had diabetes.

“In patients undergoing clinically indicated stress tests with normal perfusion scans, we observed a similar distribution of coronary microvascular dysfunction in RA compared to diabetes,” Dr Liao and colleagues concluded. “These data suggest that coronary microvascular dysfunction may contribute to the excess cardiovascular risk in RA as in diabetes. Coronary flow reserve, calculated from clinically available stress myocardial perfusion PET scans is a promising imaging biomarker to guide cardiovascular risk assessment in RA.”

—David Costill