Strategic evaluation of silent myocardial ischemia in a group of patients with rheumatoid arthritis and traditional cardiovascular risk factors

Introduction: IHD has become an important long-term end point for RA patients independent of traditional CVRF. Therefore, cardiovascular injury and mortality might be due to the presence of a chronic systematic inflammatory response. Nonetheless, there is a gap in its diagnosis since symptoms remain silent until major events occur. Objective: We aimed to evaluate by gated single-photon emission computed tomography (g-SPECT). Myocardial perfusion in asymptomatic Mexican patients with RA and at least one traditional CVRF, and without history of angina. Patients and methods: A prospective study with a total number of 91 patients was conducted. We evaluated CVRF and RA characteristics. We non-invasively assessed them with g-SPECT to reveal ischemia, territories and severity. We calculated relative risks and 95% CI of ischemia given the associated variables. Results: 22 (24.2%) patients presented ischemia, half of them in the LAD territory. Regarding CVRF and disease’s characteristics; only smokers and patients under a steroid treatment were at more risk to present ischemia (0.49 [0.24 to 0.98] and 2.04 [1.01 to 4.14], respectively) with a p = 0.046. Conclusion: We have contributed with additional evidence to strategically diagnose IHD in patients with RA even if they have no symptoms and independently of the existence of cardiovascular risk factors to prevent and reduce cardiovascular mortality.