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Use of coronarycomputed tomography for cardiovascular risk assessment in immune-mediated inflammatory diseases
  1. Marta Peverelli1,
  2. Robert T Maughan2,
  3. Deepa Gopalan3,4,
  4. Marc R Dweck5,
  5. Damini Dey6,
  6. Maya H Buch7,
  7. James H F Rudd1,
  8. Jason M Tarkin1
  1. 1Section of Cardiorespiratory Medicine, University of Cambridge, Cambridge, UK
  2. 2Imperial College London, London, UK
  3. 3Department of Radiology, Imperial College Healthcare NHS Trust, London, UK
  4. 4Department of Radiology, Cambridge University Hospitals NHS Trust, UK
  5. 5British Heart Foundation Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
  6. 6Departments of Biomedical Sciences and Medicine, Biomedical Imaging Research Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
  7. 7Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
  1. Correspondence to Dr Jason M Tarkin, Section of Cardiorespiratory Medicine, Victor Phillip Dahdaleh Heart & Lung Research Institute, University of Cambridge, Cambridge, CB2 0BB, UK; jt545{at}cam.ac.uk

Abstract

Immune-mediated inflammatory diseases (IMIDs) are recognised risk factors for accelerated atherosclerotic cardiovascular disease (CVD), particularly in younger individuals and women who lack traditional CVD risk factors. Reflective of the critical role that inflammation plays in the formation, progression and rupture of atherosclerotic plaques, research into immune mechanisms of CVD has led to the identification of a range of therapeutic targets that are the subject of ongoing clinical trials. Several key inflammatory pathways implicated in the pathogenesis of atherosclerosis are targeted in people with IMIDs. However, cardiovascular risk continues to be systematically underestimated by conventional risk assessment tools in the IMID population, resulting in considerable excess CVD burden and mortality. Hence, there is a pressing need to improve methods for CVD risk-stratification among patients with IMIDs, to better guide the use of statins and other prognostic interventions. CT coronary angiography (CTCA) is the current first-line investigation for diagnosing and assessing the severity of coronary atherosclerosis in many individuals with suspected angina. Whether CTCA is also useful in the general population for reclassifying asymptomatic individuals and improving long-term prognosis remains unknown. However, in the context of IMIDs, it is conceivable that the information provided by CTCA, including state-of-the-art assessments of coronary plaque, could be an important clinical adjunct in this high-risk patient population. This narrative review discusses the current literature about the use of coronary CT for CVD risk-stratification in three of the most common IMIDs including rheumatoid arthritis, psoriasis and systemic lupus erythematosus.

  • Computed Tomography Angiography
  • Diagnostic Imaging
  • Coronary Artery Disease
  • Atherosclerosis
  • Inflammation

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Footnotes

  • Twitter @martapeverelli, @jhfrudd

  • Contributors All authors contributed to the research and writing of this manuscript.

  • Funding Wellcome Trust (211100/Z/18/Z); BHF Cambridge Centre for Research Excellence (18/1/34212)

  • Competing interests None declared.

  • Provenance and peer review Commissioned; externally peer reviewed.