- Rheumatoid arthritis (RA) is a chronic condition that can increase the risk for other health problems, including heart disease.
- It can be a challenge for doctors to predict heart disease risk in individuals with RA.
- One recent study identified six biomarkers among individuals with RA that were associated with changes in inflammation of arteries.
- Measuring these biomarkers may help predict heart disease risk in people with RA better than current risk assessment methods.
Many factors play into the risk of developing cardiovascular disease, and for some people, the risk is much higher. One particular at-risk population is people who have rheumatoid arthritis (RA).
A recent study published in the
In their analysis of 109 participants, researchers identified six biomarkers associated with an increased risk for cardiovascular disease.
Greater understanding in this area could lead to faster detection of heart disease risk in people with RA and more prompt intervention.
Is rheumatoid arthritis linked to heart disease?
Rheumatoid arthritis (RA) is a chronic condition that often affects multiple joints, frequently causing inflammation and pain. Currently, there is no cure for RA, and treatment focuses on slowing progression and symptom management.
People with RA can also be at a
- diabetes
- anemia
- lymphoma
One of the major concerns is how people with RA have a higher risk for heart problems like coronary artery disease.
Non-study author Dr. Cheng-Han Chen, board certified interventional cardiologist and medical director of the Structural Heart Program at MemorialCare Saddleback Medical Center in Laguna Hills, CA, explained to Medical News Today:
“Patients with chronic auto-immune diseases such as rheumatoid arthritis are known to be at increased risk for having various cardiovascular diseases such as heart failure, atherosclerosis, and arrhythmias. It is thought that this may be due to the effect of persistent inflammation through circulating pro-inflammatory cytokines, and their role in microvascular dysfunction.”
Because people with RA have a higher risk for cardiovascular problems, early detection and intervention are essential. However, it is not always easy to figure out which people with RA are most at risk.
Study author Dr. Daniel H. Solomon, MPH, chief of the Section of Clinical Sciences in the Division of Rheumatology and Matthew H. Liang, Distinguished Chair at Brigham and Women’s Hospital, explained the critical setup for the research in this study:
“Cardiovascular disease is more common in people with RA than the general population. However, our current risk models don’t work as well in RA as they do in non-RA general population patients. This makes it hard to know which people with RA to consider preventive strategies. We also do not have a great handle on why people with RA are at higher cardiovascular risk than the general population. These factors drove us to look at biomarkers that might help predict cardiovascular disease and give us insights into mechanisms underpinning this risk.”
Blood biomarkers may indicate heart disease risk in RA
Researchers hoped to identify biomarkers that could indicate changes in cardiovascular disease risk in individuals with RA. Dr. Solomon explained:
“While we are not the first group to consider biomarkers for heart disease (cardiovascular disease), we focused on testing [24] likely biomarkers after reviewing other published studies from around the world. Biomarkers are molecules in your body that signal a particular physical process, condition, or disease, and can be useful for clinical assessments.”
This study analyzed data from participants in the TARGET trial. This trial looked at two different treatment regimens for RA and how they affected the risk of cardiovascular disease, ultimately finding similar results between the two groups.
For the current analysis, researchers included 109 participants who completed the baseline and follow-up biomarker measurements and scans for arterial inflammation.
Researchers excluded participants who had known cardiovascular disease. All participants had had RA for an average of 1.4 years, and the average age of participants was 58 years old.
Researchers looked at levels of these biomarkers and then at the level of inflammation in participants’ arteries. Arterial inflammation helps indicate the risk for cardiovascular events. The TARGET trial lasted for 24 weeks.
Researchers found six biomarkers that were related to changes in cardiovascular disease risk. Dr. Solomon explained:
“In our study, we measured cardiovascular risk using a PET scan of the aorta and carotid arteries. We measured the biomarkers at the beginning of the study and six months later, imaging the patients’ arteries each time to assess their arterial inflammation—an indicator of cardiovascular risk. Six of the biomarkers were associated with increased cardiovascular risk. Using them in predictive models improved our ability to predict increases in arterial inflammation compared to standard clinical indices such as the Framingham Risk Score.”
While use of these biomarkers requires more research, the current study points to a way to better predict cardiovascular disease risk for people with RA, which would help improve health outcomes among this population.
More research on RA biomarkers and heart disease risk needed
This research opens the door for future data collection but still has several limitations. It included a small sample size, and all participants had RA, limiting the generalization of the results.
The study only focused on arterial inflammation, so future research could look at other cardiovascular outcomes.
Over 80% of participants were female, meaning future studies could include more gender balance. This study lasted only six months, so future studies could be longer, allowing for more long-term follow-up.
Finally, researchers were limited by how they chose to conduct the research. For example, researchers acknowledged that they “tested many associations without correcting analyses for multiple comparisons.” Researchers recognize that a combination of biomarkers might be a stronger indicator of cardiovascular disease.
There is much opportunity for future research regarding these biomarkers and how these tests can help with risk prediction for cardiovascular disease. Dr. Solomon noted the following:
“These promising six biomarkers need to be studied in larger populations of RA patients where actual cardiovascular events were measured. Our current paper relied on PET scans, which are a good marker of cardiovascular risk, but not perfect. These next steps are currently ongoing in our research group.”
The research may also have implications beyond helping individuals with RA as well. Non-study author Dr. Sonia Rivera-Martinez, DO, an American Osteopathic Association board certified physician specializing in family medicine, offered the following speculation:
“The identification of biomarkers indicating arterial inflammation can lead to development of biological inhibitors of the specific biomarker causing the arterial inflammation and thereby preventing the development of cardiovascular disease. This could lead to treatment for others beyond patients with rheumatoid arthritis.”
