Heart disease is the leading cause of death worldwide, and for people living with rheumatoid arthritis (RA), the risk is significantly higher. While RA is commonly recognized for causing painful joint inflammation, the disease also triggers chronic inflammation throughout the body that can accelerate atherosclerotic plaque build-up in arteries and increase the likelihood of heart attacks and strokes.
In a new study published in Rheumatology, a team of researchers found that inflammation surrounding the major arteries of the heart may provide important insights into cardiovascular health that extend beyond traditional risk assessments. George A. Karpouzas, MD, investigator at The Lundquist Institute for Biomedical Innovation and lead author on the study, is hopeful that these findings will open new doors for early detection and intervention.
The study examined a novel imaging marker known as pericoronary adipose tissue attenuation (PCATa), which measures changes in the enhancement and appearance of the fat tissue surrounding the coronary arteries. Researchers found that higher levels of this marker were associated with more lipid-rich atherosclerotic plaques, suggesting that inflammation around the arteries may serve as an important indicator of cardiovascular risk in individuals with RA. Importantly, the biomarker optimized cardiovascular risk estimates beyond traditional risk factors, and coronary atherosclerosis itself.
“For many patients with rheumatoid arthritis, cardiovascular disease develops silently for years and the risk of silent events or sudden cardiac death as a first manifestation of atherosclerosis is significantly more common than in patients without this disease” said Dr. Karpouzas. “Our goal is to identify those at highest risk earlier so that preventive measures can be timely implemented.”
The findings represent an important step forward in understanding the connection between chronic inflammatory diseases and heart health. Traditional cardiovascular risk assessments focus on factors such as cholesterol levels, blood pressure, diabetes, smoking history, and family history. While these measures remain essential to consider, they often fail to fully capture the impact of chronic inflammation—a key driver of cardiovascular disease in patients with RA.
This research suggests that evaluating inflammation directly around the coronary arteries may offer clinicians a more comprehensive picture of cardiovascular health. In the future, imaging-based tools such as PCATa could help physicians better personalize treatment strategies and improve preventive care for patients living with inflammatory diseases.
For Dr. Karpouzas, the work reflects years of research dedicated to understanding why people with rheumatoid arthritis face disproportionately high rates of cardiovascular disease. His research program focuses on uncovering the mechanisms that connect inflammation and atherosclerosis and developing innovative methods to improve cardiovascular risk assessment and prevention.
To read the publication and learn more about the study, visit https://doi.org/10.1093/rheumatology/keag239.