Rheumatology
Rheumatoid Arthritis
High-Sensitivity Cardiac Troponin I in Patients With Rheumatoid Arthritis
Overview
Clinical Study Title:
High-Sensitivity Cardiac Troponin I Is a Biomarker for Occult Coronary Plaque Burden and Cardiovascular Events in Patients With Rheumatoid Arthritis
Clinical Study Abstract:
OBJECTIVES: Patients with RA display greater occult coronary atherosclerosis burden and experience higher cardiovascular morbidity and mortality compared with controls. We here explored whether pro-inflammatory cytokines and high-sensitivity cardiac troponin I (hs-cTnI), a biomarker of myocardial injury, correlated with plaque burden and cardiovascular events (CVEs) in RA.
METHODS: We evaluated 150 patients with 64-slice coronary CT angiography. Coronary artery calcium, number of segments with plaque (segment involvement score), stenotic severity and plaque burden were assessed. Lesions were described as non-calcified, mixed or fully calcified. Blood levels of hs-cTnI and pro-inflammatory cytokines were assessed during coronary CT angiography. Subjects were followed over 60 (s.d. 26) months for both ischaemic [cardiac death, non-fatal myocardial infarction (MI), stroke, peripheral arterial ischaemia] and non-ischaemic (new-onset heart failure hospitalization) CVEs.
RESULTS: Plasma hs-cTnI correlated with all coronary plaque outcomes (P < 0.01). Elevated hs-cTnI (⩾1.5 pg/ml) further associated with significant calcification, extensive atherosclerosis, obstructive plaque and any advanced mixed or calcified plaques after adjustments for cardiac risk factors or Framingham D’Agostino scores (all P < 0.05). Eleven patients suffered a CVE (1.54/100 patient-years), eight ischaemic and three non-ischaemic. Elevated hs-cTnI predicted all CVE risk independent of demographics, cardiac risk factors and prednisone use (P = 0.03). Conversely, low hs-cTnI presaged a lower risk for both extensive atherosclerosis (P < 0.05) and incident CVEs (P = 0.037).
CONCLUSION: Plasma hs-cTnI independently associated with occult coronary plaque burden, composition and long-term incident CVEs in patients with RA. Low hs-cTnI forecasted a lower risk for both extensive atherosclerosis as well as CVEs. hs-cTnI may therefore optimize cardiovascular risk stratification in RA.
Reference:
Karpouzas GA, Estis J, Rezaeian P, Todd J, Budoff MJ. High-sensitivity cardiac troponin I is a biomarker for occult coronary plaque burden and cardiovascular events in patients with rheumatoid arthritis. Rheumatology (Oxford ). 2018;57(6):1080-1088.
Expert Commentary
Alan L. Epstein, MD
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“The fascinating, simple, and—hopefully—reliable biomarker evaluated in this study by Karpouzas and colleagues may allow us to perform better cardiovascular risk assessment in patients with RA.”
As rheumatologists, we are aware that our patients with rheumatoid arthritis (RA) are at an increased risk for cardiovascular disease (CVD) and that this increased risk is similar to that associated with diabetes. Current CVD risk algorithms developed for the general population are not accurate in patients with RA. The European League Against Rheumatism recommends that CVD risk algorithms developed for the general population be corrected for patients with RA by using a 1.5 multiplication factor; however, the multiplier is not based on direct evidence. Further, the American College of Rheumatology does not have such a CVD risk assessment guideline for individuals with RA.
Thus, the fascinating, simple, and—hopefully—reliable biomarker evaluated in this study by Karpouzas and colleagues may allow us to perform better cardiovascular risk assessment in patients with RA. The investigators were able to show a link between elevated hs-cTnl and all coronary plaque outcomes, including significant calcification, extensive atherosclerosis, obstructive plaque, and any advanced mixed or calcified plaques after adjustments for cardiac risk factors or Framingham D’Agostino score. In addition, elevated levels of hs-cTnl were also associated with an increased risk of long-term CVEs, while, conversely, low levels of hs-cTnI were associated with less coronary plaque burden and a lower risk of long-term CVEs. These study results suggest that this simple blood test may be a useful risk assessment tool that would be easier for clinicians to perform than a more extensive, in-depth risk assessment.
References
Agca R, Heslinga SC, Rollefstad S, 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.
Aviña-Zubieta JA, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum. 2008;59(12):1690-1697.
Crowson CS, Gabriel SE, Semb AG, et al; Trans-Atlantic Cardiovascular Consortium for Rheumatoid Arthritis. Rheumatoid arthritis-specific cardiovascular risk scores are not superior to general risk scores: a validation analysis of patients from seven countries. Rheumatology (Oxford). 2017;56(7):1102-1110.
Giles JT, Post WS, Blumenthal RS, et al. Longitudinal predictors of progression of carotid atherosclerosis in rheumatoid arthritis. Arthritis Rheum. 2011;63(11):3216-3225.
