Novel Biomarkers and Advanced Imaging in Cardiovascular Risk Stratification for Rheumatic Diseases

Area of Science:

• Cardiology
• Rheumatology
• Immunology

Background:

• Rheumatic diseases like rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) markedly increase cardiovascular disease (CVD) risk (2-3 fold).
• Chronic inflammation and accelerated atherosclerosis in these conditions are not adequately addressed by standard CVD risk calculators.
• RA patients have CVD risks comparable to type 2 diabetics, and SLE patients face a high risk of myocardial infarction, especially young women.

Purpose of the Study:

• To review the pathophysiological mechanisms linking rheumatic diseases to increased cardiovascular risk.
• To explore the role of novel biomarkers and advanced imaging in improving CVD risk stratification and early detection in rheumatic disease patients.
• To highlight the limitations of traditional risk calculators and the need for integrated approaches.

Main Methods:

• Review of literature on pathophysiological mechanisms, focusing on chronic inflammation, immune dysregulation, and vascular dysfunction.
• Analysis of the utility of established and emerging biomarkers (e.g., hs-CRP, NT-proBNP, troponins, IL-32, DKK-1, galectin-3).
• Evaluation of advanced imaging techniques (e.g., TTE, carotid ultrasonography, CMR, CCTA) for detecting subclinical cardiovascular changes.

Main Results:

• Chronic inflammation, driven by cytokines like TNF-α, IL-6, and IL-17, promotes endothelial dysfunction and oxidative stress, accelerating atherosclerosis.
• Biomarkers (hs-CRP, NT-proBNP, troponins) aid in detecting subclinical cardiac issues and predicting outcomes; novel biomarkers show promise.
• Advanced imaging reveals subclinical myocardial inflammation, fibrosis, and early atherosclerosis, guiding clinical decisions.

Conclusions:

• Traditional CVD risk calculators underestimate risk in rheumatic disease patients, necessitating adjusted models (e.g., EULAR 1.5x multiplier).
• Integrating biomarkers and advanced imaging offers more accurate CVD risk assessment and personalized management for rheumatic disease patients.
• Further research is needed on multi-biomarker algorithms, imaging technology, and intervention trials to optimize cardiovascular outcomes.