Epicardial fat as a cardiovascular risk factor in inflammatory arthritis.

BACKGROUND AND AIMS: Cardiovascular disease (CVD) is the leading cause of death in inflammatory arthritis. Epicardial fat has emerged as a novel marker of CVD. Therefore, we examined the association of epicardial fat volume (EFV) with disease activity and other atherosclerotic CV markers in patients with inflammatory arthritis.

METHODS

Patients with rheumatoid arthritis (RA) (n = 114) and spondyloarthritis (SpA), including ankylosing spondylitis (n = 28) and psoriatic arthritis (n = 100) were recruited. EFV was assessed from coronary artery calcium scoring (CACS) computed tomography scans. Additionally, carotid atherosclerotic markers were obtained by carotid ultrasound. We compared EFV between RA and SpA patients and assessed the association between EFV and disease activity indices, inflammatory and atherosclerotic markers using regression models adjusted for age, sex and the Framingham risk score (FRS).

RESULTS

EFV was significantly higher in SpA versus RA after adjusting for age and sex ((104.2 ± 46.7 vs. 86.7 ± 47.9 ml, p = 0.004; β 18.3, 95% confidence interval (CI) 5.5-31.1) or after adjusting for FRS (β 17.4, 95% CI 5.8-28.9). While high sensitivity C-reactive protein was associated with elevated EFV (β adjusted for FRS 0.97, 95% CI 0.39-1.56), no similar association was found between individual arthritis-clinical disease activity indices and EFV. Among atherosclerotic markers, only CACS was associated with elevated EFV (β adjusted for FRS 0.02, 95% CI 0.01-0.05).

CONCLUSION

Higher EFV in SpA and its association with inflammatory markers and coronary atherosclerosis highlight the increased CV risk in this population.