Screening and Management of Atherosclerotic Cardiovascular Disease in Inflammatory Arthritis: A Comprehensive Approach for the Rheumatologist

Authors

  • Shadi Akhtari, MD, MSc Division of Cardiology, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
  • Bindee Kuriya, MD, SM Division of Rheumatology, Sinai Health System, University of Toronto, Toronto, Ontario, Canada

DOI:

https://doi.org/10.58931/crt.2024.1251

Abstract

Inflammatory arthritis (IA) is associated with an increased risk of atherosclerotic cardiovascular disease (ASCVD) and contributes to significant morbidity and mortality. Early identification and treatment of conventional cardiovascular disease (CVD) risk factors are pivotal in mitigating ASCVD risk among the IA population. Equally crucial is the proactive management of inflammatory disease, necessitating a thorough discussion of the risks and benefits, particularly regarding the use of some advanced therapeutic agents indicated for IA, which may carry an increased risk of CVD in high‑risk subgroups. 

This article reviews the current evidence for optimal CVD screening in IA. We underscore the importance of a holistic approach that incorporates conventional risk assessment tools, biomarkers, imaging techniques, and interdisciplinary cooperation.

Author Biographies

Shadi Akhtari, MD, MSc, Division of Cardiology, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada

Dr. Akhtari is a staff cardiologist at Women’s College Hospital, Assistant Professor in the Department of Medicine, and a Clinician in Quality and Innovation, University of Toronto. She specializes in advanced cardiac imaging. Apart from clinical practice of general cardiology and multi-modality cardiac imaging, her other areas of interest are prevention, diagnosis, and management of coronary artery disease, particularly in those with underlying inflammatory disease. She runs the cardio-rheumatology clinic at WCH, directed at improving quality of cardiac care offered to patients with rheumatic disease.

Bindee Kuriya, MD, SM, Division of Rheumatology, Sinai Health System, University of Toronto, Toronto, Ontario, Canada

Dr. Kuriya is an expert in rheumatoid arthritis, and her research primarily focuses on important co-morbidities such as cardiovascular disease. She is a member of the University of Toronto’s Cardio-Rheum Program, which is aimed at primary CVD prevention for patients living with inflammatory arthritis.

References

Heslinga M, Nielen MMJ, Smulders Y, Simsek S, Nurmohamed MT. Amplified prevalence and incidence of cardiovascular disease in patients with inflammatory arthritis and coexistent autoimmune disorders. Rheumatology (Oxford). 2020. doi:10.1093/rheumatology/kez650 DOI: https://doi.org/10.1093/rheumatology/kez650

Mason JC, Libby P. Cardiovascular disease in patients with chronic inflammation: mechanisms underlying premature cardiovascular events in rheumatologic conditions. Eur Heart J. 2015;36(8):482-489c. doi:10.1093/eurheartj/ehu403 DOI: https://doi.org/10.1093/eurheartj/ehu403

Hajiesmaeili Y, Tamhankar P, Stranges S, Barra L. Factors associated with incident cardiovascular disease in patients with rheumatoid arthritis: a scoping review. Autoimmun Rev. 2024;23(5):103539. doi:10.1016/j.autrev.2024.103539 DOI: https://doi.org/10.1016/j.autrev.2024.103539

Crowson CS, Rollefstad S, Ikdahl E, Kitas GD, van Riel PLCM, Gabriel SE, et al. Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis. Ann Rheum Dis. 2018;77(1):48-54. doi:10.1136/annrheumdis-2017-211735 DOI: https://doi.org/10.1136/annrheumdis-2017-211735

Bartels CM, Roberts TJ, Hansen KE, Jacobs EA, Gilmore A, Maxcy C, et al. Rheumatologist and primary care management of cardiovascular disease risk in rheumatoid arthritis: patient and provider perspectives. Arthritis Care Res (Hoboken). 2015. doi:10.1002/acr.22689 DOI: https://doi.org/10.1002/acr.22689

Chodara AM, Wattiaux A, Bartels CM. Managing cardiovascular disease risk in rheumatoid arthritis: clinical updates and three strategic approaches. Curr Rheumatol Rep. 2017;19(4):16. doi:10.1007/s11926-017-0643-y DOI: https://doi.org/10.1007/s11926-017-0643-y

Agca R, Hopman LHGA, Laan KJC, van Halm VP, Peters MJL, Smulders YM, et al. Cardiovascular event risk in rheumatoid arthritis compared with type 2 diabetes: a 15-year longitudinal study. J Rheumatol. 2020;47(3):316-324. doi:10.3899/jrheum.180726 DOI: https://doi.org/10.3899/jrheum.180726

Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJ, et al. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis. 2017;76(1):17-28. doi:10.1136/annrheumdis-2016-209775 DOI: https://doi.org/10.1136/annrheumdis-2016-209775

Colaco K, Ocampo V, Ayala AP, Harvey P, Gladman DD, Piguet V, et al. Predictive utility of cardiovascular risk prediction algorithms in inflammatory rheumatic diseases: a systematic review. J Rheumatol. 2020;47(6):928-938. doi:10.3899/jrheum.190261 DOI: https://doi.org/10.3899/jrheum.190261

Gonzalez-Gay MA, Gonzalez-Juanatey C. Inflammation and lipid profile in rheumatoid arthritis: bridging an apparent paradox. Ann Rheum Dis. 2014;73(7):1281-1283. doi:10.1136/annrheumdis-2013-204933 DOI: https://doi.org/10.1136/annrheumdis-2013-204933

Peters MJ, Symmons DP, McCarey D, Dijkmans BA, Nicola P, Kvien TK, et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis. 2010;69(2):325-331. doi:10.1136/ard.2009.113696 DOI: https://doi.org/10.1136/ard.2009.113696

Navarini L, Margiotta DPE, Caso F, Currado D, Tasso M, Angeletti S, et al. Performances of five risk algorithms in predicting cardiovascular events in patients with psoriatic arthritis: an Italian bicentric study. PLoS One. 2018;13(10):e0205506. doi:10.1371/journal.pone.0205506 DOI: https://doi.org/10.1371/journal.pone.0205506

Arts EE, Popa CD, Den Broeder AA, Donders R, Sandoo A, Toms T, et al. Prediction of cardiovascular risk in rheumatoid arthritis: performance of original and adapted SCORE algorithms. Ann Rheum Dis. 2016;75(4):674-680. doi:10.1136/annrheumdis-2014-206879 DOI: https://doi.org/10.1136/annrheumdis-2014-206879

Misra DP, Hauge EM, Crowson CS, Kitas GD, Ormseth SR, Karpouzas GA. Atherosclerotic cardiovascular risk stratification in the rheumatic diseases: an integrative, multiparametric approach. Rheum Dis Clin North Am. 2023;49(1):19-43. doi:10.1016/j.rdc.2022.07.004 DOI: https://doi.org/10.1016/j.rdc.2022.07.004

Barber CE, Marshall DA, Alvarez N, Mancini GB, Lacaille D, Keeling S, et al. Development of cardiovascular quality indicators for rheumatoid arthritis: results from an international expert panel using a novel online process. J Rheumatol. 2015;42(9):1548-1555. doi:10.3899/jrheum.141603 DOI: https://doi.org/10.3899/jrheum.141603

Barber CE, Esdaile JM, Martin LO, Faris P, Barnabe C, Guo S, et al. Gaps in Addressing cardiovascular risk in rheumatoid arthritis: assessing performance using cardiovascular quality indicators. J Rheumatol. 2016;43(11):1965-1973. doi:10.3899/jrheum.160241 DOI: https://doi.org/10.3899/jrheum.160241

Canada HaSFo. Canadian Physical Activity Guidelines Canadian Sedentary Behaviour Guidelines [Available from: https://www.heartandstroke.ca/healthy-living/stay-active.

Pearson GJ, Thanassoulis G, Anderson TJ, Barry AR, Couture P, Dayan N, et al. 2021 Canadian Cardiovascular Society Guidelines for the management of dyslipidemia for the prevention of cardiovascular disease in the adult. Can J Cardiol. 2021. doi:10.1016/j.cjca.2021.03.016 DOI: https://doi.org/10.1016/j.cjca.2021.03.016

Roubille C, Richer V, Starnino T, McCourt C, McFarlane A, Fleming P, et al. The effects of tumour necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis. Ann Rheum Dis. 2015;74(3):480-489. doi:10.1136/annrheumdis-2014-206624 DOI: https://doi.org/10.1136/annrheumdis-2014-206624

Ridker PM. Closing the loop on inflammation and atherothrombosis: why perform the CIRT and CANTOS trials? Trans Am Clin Climatol Assoc. 2013;124:174-190.

Avouac J, Fogel O, Hecquet S, Daien C, Elalamy I, Picard F, et al. Recommendations for assessing the risk of cardiovascular disease and venous thromboembolism before the initiation of targeted therapies for chronic inflammatory rheumatic diseases. Joint Bone Spine. 2023;90(5):105592. doi:10.1016/j.jbspin.2023.105592 DOI: https://doi.org/10.1016/j.jbspin.2023.105592

Liao KP, Playford MP, Frits M, Coblyn JS, Iannaccone C, Weinblatt ME, et al. The association between reduction in inflammation and changes in lipoprotein levels and HDL cholesterol efflux capacity in rheumatoid arthritis. J Am Heart Assoc. 2015;4(2). doi:10.1161/JAHA.114.001588 DOI: https://doi.org/10.1161/JAHA.114.001588

Giles JT, Sattar N, Gabriel S, Ridker PM, Gay S, Warne C, Musselman D, Brockwell L, Shittu E, Klearman M, Fleming TR. Cardiovascular Safety of Tocilizumab Versus Etanercept in Rheumatoid Arthritis: A Randomized Controlled Trial. Arthritis Rheumatol. 2020 Jan;72(1):31-40. doi: 10.1002/art.41095. PMID: 31469238. DOI: https://doi.org/10.1002/art.41095

Ytterberg SR, Bhatt DL, Connell CA. Cardiovascular and Cancer Risk with Tofacitinib in Rheumatoid Arthritis. Reply. N Engl J Med. 2022;386(18):1768. doi:10.1056/NEJMc2202778 DOI: https://doi.org/10.1056/NEJMc2202778

Yang V, Kragstrup TW, McMaster C, Reid P, Singh N, Haysen SR, et al. Managing Cardiovascular and cancer risk associated with JAK inhibitors. Drug Saf. 2023;46(11):1049-1071. doi:10.1007/s40264-023-01333-0 DOI: https://doi.org/10.1007/s40264-023-01333-0

Misra DP, Pande G, Agarwal V. Cardiovascular risks associated with Janus kinase inhibitors: peering outside the black box. Clin Rheumatol. 2023;42(2):621-632. doi:10.1007/s10067-022-06415-5 DOI: https://doi.org/10.1007/s10067-022-06415-5

Navarro-Millan I, Cornelius-Schecter A, O’Beirne RJ, Morris MS, Lui GE, Goodman SM, et al. Views of primary care physicians and rheumatologists regarding screening and treatment of hyperlipidemia among patients with rheumatoid arthritis. BMC Rheumatol. 2020;4:14. doi:10.1186/s41927-020-0112-5 DOI: https://doi.org/10.1186/s41927-020-0112-5

Kuriya B, Akhtari S, Movahedi M, Udell JA, Lawler PR, Farkouh ME, et al. Statin use for primary cardiovascular disease prevention is low in inflammatory arthritis. Can J Cardiol. 2022;38(8):1244-1252. doi:10.1016/j.cjca.2022.04.002 DOI: https://doi.org/10.1016/j.cjca.2022.04.002

Weber B, Garshick M, Liao KP, Di Carli M. Sore, Hot, and at Risk: The Emerging Specialty of Cardio-Rheumatology. J Am Heart Assoc. 2023;12(11):e027846. doi:10.1161/JAHA.122.027846 DOI: https://doi.org/10.1161/JAHA.122.027846

Downloads

Published

2024-09-17

How to Cite

1.
Akhtari S, Kuriya B. Screening and Management of Atherosclerotic Cardiovascular Disease in Inflammatory Arthritis: A Comprehensive Approach for the Rheumatologist. Can Rheumatol Today [Internet]. 2024 Sep. 17 [cited 2024 Nov. 21];1(2):30–40. Available from: https://canadianrheumatologytoday.com/article/view/1-2-Akhtari_et_al

Issue

Volume 1, Issue 2, Summer 2024

Section

Articles

License

Copyright (c) 2024 Canadian Rheumatology Today

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.