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Epicardial fat as a cardiovascular risk factor in inflammatory arthritis

Shubhabrata Das1, Wei Wu2, Paula Harvey3

  • 1Division of Internal Medicine, Department of Medicine, University of Toronto.

Seminars in Arthritis and Rheumatism
|April 28, 2026
PubMed

Insights

Epicardial fat volume (EFV) is higher in spondyloarthritis (SpA) than rheumatoid arthritis (RA) patients. Higher EFV correlates with inflammatory markers and coronary atherosclerosis, indicating increased cardiovascular risk in SpA.

Area of Science:

  • Cardiology
  • Rheumatology
  • Medical Imaging

Background:

  • Cardiovascular disease (CVD) is the primary cause of mortality in patients with inflammatory arthritis.
  • Epicardial fat volume (EFV) is an emerging biomarker for CVD.
  • Inflammatory arthritis encompasses conditions like rheumatoid arthritis (RA) and spondyloarthritis (SpA).

Purpose of the Study:

  • To investigate the association between epicardial fat volume (EFV) and disease activity in inflammatory arthritis.
  • To compare EFV between RA and SpA patients.
  • To explore the relationship of EFV with other markers of cardiovascular disease (CVD).

Main Methods:

  • Recruited patients with RA (n=114) and SpA (n=128).
  • Assessed EFV using computed tomography scans (coronary artery calcium scoring).
  • Evaluated carotid atherosclerotic markers via ultrasound and analyzed associations using regression models adjusted for age, sex, and Framingham risk score (FRS).

Main Results:

  • EFV was significantly higher in SpA compared to RA patients after adjustments.
  • Elevated EFV showed an association with high-sensitivity C-reactive protein (hs-CRP).
  • Coronary artery calcium scoring (CACS) was the only atherosclerotic marker associated with increased EFV.

Conclusions:

  • Spondyloarthritis patients exhibit higher epicardial fat volume (EFV) compared to rheumatoid arthritis patients.
  • The association of EFV with inflammatory markers and coronary atherosclerosis underscores heightened cardiovascular risk in SpA.
  • EFV serves as a potential indicator of cardiovascular risk in inflammatory arthritis populations.
Abstract

Keywords:
Ankylosing spondylitisCardiovascular diseasePsoriatic arthritisRheumatoid arthritisRisk factorsSpondyloarthropathy

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