Patients with rheumatoid arthritis, lupus and other chronic forms of inflammatory arthritis can face life-threatening complications, and heart disease tops the list. People with such rheumatic diseases are twice as likely as the average person to develop heart problems. Catching heart disease early is critical. Mayo cardiologists and rheumatologists have joined forces to create the Mayo Clinic Cardio-Rheumatology Clinic to pioneer new diagnostic tools and break this dangerous disease connection.
Mayo Clinic has found that the traditional methods used to pinpoint heart disease risk, such as the Framingham Risk Score, do not work very well in rheumatic disease patients, because their heart disease may manifest itself in a different and more subtle way. To prevent, detect and treat heart problems as early as possible, the Cardio-Rheumatology Clinic examines a broader spectrum of risk factors.
"We offer patients a more detailed assessment of their cardiovascular status and a more detailed examination of risk factors besides the usual conventional risk factors such as lipids, cholesterol and smoking," says Eric Matteson, M.D., Mayo Clinic rheumatology chair, who is moderating a presentation Saturday on "cardio rheumatology" during an American Heart Association scientific meeting in Dallas. "We also are taking into account the rheumatic disease burden, the disease activity and the treatment of the rheumatic disease as a factor for mitigating cardiovascular risk."
In part based on Mayo Clinic research, Cardio-Rheumatology Clinic physicians are employing new ultrasound techniques to evaluate blood vessels for the earliest signs of heart disease.
"By evaluating and educating our patients early on in their rheumatic disease processes, we hope to be able to understand the mechanisms and make a difference in the development and severity of their atherosclerotic complications," says Sharon Mulvagh, M.D., a cardiologist and director of the Mayo Clinic's Women's Heart Clinic, noting heart attack and stroke risk in particular.
Because women are more commonly affected by autoimmune disorders, the Cardio-Rheumatology Clinic will be located within the Women's Heart Clinic. Physicians plan to publish their findings from the clinic as part of a long-standing Mayo Clinic effort to identify the factors driving heart disease in rheumatic disease patients, reduce risk and slow the progression of heart disease.
There is some evidence that moderating inflammation through treatment reduces the risk of heart disease in patients with rheumatic diseases, Dr. Matteson says. But, physicians do not really know why there is this connection between heart problems and rheumatic diseases, he adds.
"We think it must have to do with the inflammatory burden of the rheumatic disease; that is, the same process that leads to inflammation in the joints, for instance in rheumatoid arthritis, may also affect the lining of the blood vessels," Dr. Matteson says.
There may be other mechanisms at work in how inflammation affects the heart, he adds.
Mayo Clinic research recently presented at the American College of Rheumatology annual meeting in San Diego found that early menopause, more severe rheumatoid arthritis and immunity to a common virus, cytomegalovirus, seem to put rheumatoid arthritis patients in greater jeopardy of heart problems.
Previous Mayo studies found that broken bones put rheumatoid arthritis patients in greater danger of heart disease and death, and that rheumatoid arthritis patients with cardiovascular disease are more likely to test positive for rheumatoid factor in their blood, and those who are positive for rheumatoid factor seem to have immune systems that age faster and also have accelerated risk of cardiovascular disease.
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