Those who deal with rheumatoid arthritis, as also happens with other chronic inflammatory rheumatological diseases, may be at greater risk of a heart attack. And therefore you must pay particular attention to the factors that endanger the circulatory system. But there is a problem: in this population it is more complex to identify who is more likely to develop an ischemic pathology, given that classic parameters such as LDL cholesterol, age and smoking tend to lead to an underestimation of potential risks.
A hope for better understanding on whom to concentrate the maximum care in terms of preventing heart attacks and strokes now comes from an American research, coordinated by experts from the Massachusetts General Hospital and the Brigham and Women’s Hospital, which appeared in the Journal of American Heart Association. The study (first author Daniel H. Solomon) identifies six specific parameters, which can be obtained by specialists with blood tests, capable of defining more precisely who, among those suffering from rheumatoid arthritis, must pay more attention to cardiovascular risk. We are only at the beginning and further investigations will have to confirm the predictive impact of this battery of tests. But the road appears interesting.
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How did we come to identify these parameters?
The analysis that led to the identification of the six potential indicators of a higher cardiovascular risk, in addition to the classic elements of danger for the heart and arteries, comes from the TARGET study (Treatments Against RA and Effect on FDG PET/CT).
The research was conducted to evaluate the impact of therapies for rheumatological disease on heart and artery health. In this sense, in addition to very specific tests, 24 markers were identified which were evaluated at the beginning of the study and after approximately six months in the patients (109 in total, over 80% women) included in the research.
From this “screening” of potential markers, we were able to identify the six parameters that appear associated with changes in the cardiovascular risk profile: serum amyloid A, C-reactive proteinthe soluble tumor necrosis factor receptor 1, theadiponectinaYKL-40 (an inflammation parameter) andosteoprotegerinwhich comes into play in bone metabolism.
Let’s be clear. we are at the beginning. Further research is needed to determine whether biomarkers can definitely be associated with cardiovascular events such as heart attack or stroke, also given the limited number of subjects studied.
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Eyes on inflammation
“Inflammation can predict future risk of cardiovascular disease – is the comment reported in a note from the hospital Ahmed Tawakolof the Massachusetts General Hospital”. For this reason, biomarkers could become, at least in part, means of routine monitoring of cardiovascular health in patients with rheumatological diseases. Because the more inflammation increases (to also be evaluated with other types of tests) , the greater the probability that the person will undergo an evolution towards stroke and/or heart attack.
The inflammatory condition is precisely the “link” that brings together atherosclerosis and rheumatological disease. For this reason, prevention objectives must be pursued with maximum commitment in subjects at high risk.
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How to behave?
“Rheumatoid arthritis is a pathology characterized by joint and systemic inflammation – he explains Roberto Caporali, full professor of rheumatology at the University of Milan and director of the rheumatology and medical sciences department, Asst Gaetano Pini Cto. It has been known for years that cardiovascular diseases are more frequent in these patients than in the general population, represent a serious problem in these patients, and may also be related to an increase in mortality. Rheumatoid arthritis represents in itself a cardiovascular risk factor, which is added to any “classic” risk factors”.
Furthermore, to remind us of this, there are also indications from many scientific societies (including the SIR – Italian Society of Rheumatology) which advise patients with rheumatoid arthritis to multiply the cardiovascular risk calculated with the classic scores by 1.5. It is therefore essential to identify the patient and propose a therapy tailored to the individual case. “Controlling inflammation and achieving remission in these patients as quickly as possible allows us to dramatically reduce the cardiovascular risk linked to the disease and therefore reduce mortality – concludes Caporali”.
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