Thursday, 6 November 2014

Heart Disease in the Rheumatoid Arthritis Patient

Dr Sherine Gabriel, Dean at Mayo Medical School in Rochester gave a gripping talk about cardiovascular disease in Rheumatoid Arthritis. This is a topic that I worry about so I was happy to hear facts from such an established researcher and author.

She told us that in RA there is an elevated prevalence of ischemic heart disease, with the risk increased three to sixfold. Our smouldering autoimmune disease drives vascular disease.

She mentioned a study by John M Davis III et al. (including herself) called: A signature of aberrant immune responsiveness identifies myocardial dysfunction in rheumatoid arthritis published in Arthritis and Rheumatism. The main conclusion: "Evidence suggests that immune mechanisms contribute to myocardial injury and fibrosis, leading to left ventricular diastolic dysfunction (LVDD)" Even in the general population diastolic dysfunction is associated with increased mortality.

The Framingham Score, and the HeartSCORE, commonly used in Europe to predict risk are poor predictors of cardiovascular disease in RA.

The ATACC-RA risk score is a more accurate predictor of 10 year risk for cardiovascular disease. ATAAC-RA is the acronym for A TransAtlantic Cardiovascular risk Calculator for Rheumatoid Arthritis. I think the logo is great and I look forward to seeing this tool used by my doctors.

There are 496 publications related to CVD and RA by the collaborators in the ATACC-RA consortium. That is a good demonstration of the expertise involved. 

At the end of this talk I was wondering if being a medical educator accounts for Dr Gabriel's skill in keeping the interest of the audience and presenting information in such a memorable way.

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