Non-invasive Cardiovascular Imaging for Cardiovascular Risk Assessment in Rheumatoid Arthritis

People with rheumatoid arthritis (RA) are often under-recognised as a group with elevated risk of cardiovascular (CV) disease and increased morbidity from CV events. Standard clinical risk assessment tools, which take into account traditional CV risk factors such as smoking, diabetes, hypertension, hyperlipidaemia, and family history do not accurately predict CV risk in patients with autoimmune rheumatic disorders; therefore, there is an unmet need for other methods to assess their risk. Non-invasive CV imaging is evolving as a novel clinical tool to determine subclinical atherosclerotic coronary artery disease in patients with RA. Non-invasive imaging studies, such as tests of endothelial function (i.e. reactive hyperaemia index and flow-mediated dilation) and arterial stiffness (i.e. pulse-wave velocity), have been identified as a potential means for providing accurate assessment of early CV risk in the general population and are evolving in their utility for patients with RA. These types of non-invasive imaging have the potential to eliminate the current use of invasive assessments for identification of precursors to coronary artery disease, such as coronary angiography for early endothelial cell dysfunction. By combining the expertise of subspecialists in cardio-rheumatology clinics, the expectation is to pre-emptively identify RA patients with early coronary artery disease, allowing early modification of risk factors through either medical management or lifestyle modification.