Rheumatoid arthritis (RA) is a chronic autoimmune disease that not only affects the joints but also increases the risk of cardiovascular events and mortality in patients. Recent research conducted by Katherine P. Liao, MD, MPH, and her colleagues at Brigham and Women’s Hospital in Boston suggests that regular high-sensitivity cardiac troponin T (hs-cTnT) testing may be beneficial for RA patients in assessing their cardiovascular risk.
The study followed a group of RA patients for an average of 5 years and found a significant association between positive hs-cTnT test results and the subsequent risk of major adverse cardiovascular events (MACE). Even after adjusting for standard risk factors and C-reactive protein levels, patients with detectable hs-cTnT had a much higher risk of MACE and all-cause mortality. This indicates that conventional risk factors alone may not fully account for the increased cardiovascular risk in RA patients.
While it is well-known that RA patients have an elevated risk of cardiovascular events and mortality, identifying those at high risk remains a challenge. Conventional predictive models such as the “hard” Framingham score may not accurately predict MACE risk in these patients. Despite incorporating additional factors like CRP and measures of RA disease activity, there is still a gap in cardiovascular risk assessment.
The researchers proposed using hs-cTnT testing to potentially fill this gap in cardiovascular risk assessment for RA patients. Previous studies have shown the value of high-sensitivity testing for troponin I in predicting cardiovascular events. By analyzing blood samples collected from RA patients in the longitudinal BRASS study, Liao’s group was able to assess the association between hs-cTnT levels and MACE risk over 10 years.
Out of over 1,500 BRASS participants, 331 were included in the analysis based on sufficient data availability. The majority of the participants were women, with a mean age of 58 years at baseline and a median RA disease duration of 12 years. While most patients had relatively low predicted MACE risk based on standard heart risk testing, the actual 10-year MACE rate was higher than expected, with 15% of the cohort experiencing mortality during the follow-up period.
Positive hs-cTnT results were associated with a significantly increased MACE risk in RA patients, even after adjusting for other risk factors. This suggests that hs-cTnT may serve as an independent risk factor for cardiovascular events and mortality in RA patients. Future studies should explore the utility of screening asymptomatic RA patients using hs-cTnT to assess their cardiovascular risk and potentially improve outcomes.
High-sensitivity cardiac troponin T testing holds promise in helping healthcare providers identify RA patients at increased risk of cardiovascular events and mortality. By incorporating hs-cTnT testing into routine care for RA patients, clinicians may be able to implement targeted interventions and preventive measures to improve outcomes in this high-risk population. Further research is needed to validate the findings of this study and determine the long-term benefits of hs-cTnT testing in managing cardiovascular risk in RA patients.
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