ISCHEMIC AND NON-ISCHEMIC HEART LESIONS IN PATIENTS WITH RHEUMATOID ARTHRITIS. I. CLINICAL AND SUBCLINICAL CHANGES IN THE MYOCARDIUM, PREVALENCE AND SEVERE OF ATHEROSCLEROSIS, PECULIARITIES OF INFLUENCE OF TRADITIONAL FACTORS OF RISK, ROLE OF SYSTEMIC INFLAMMATION
Summary. The paper analyzes the literature on the reasons for a significant increase (by about 50%) in the risks of cardiovascular events in patients with rheumatoid arthritis. It has been shown that the prevalence and severity of coronary plaques is higher in rheumatoid arthritis, and the incidence of myocardial infarction is 70% higher than in the general population. At the same time, other mechanisms are responsible for mortality among patients with rheumatoid arthritis, and traditional risk factors are significantly less important. The risk of myocardial infarction in rheumatoid arthritis is not related to disease activity, but to C-reactive protein levels. Subclinical changes in the myocardium of patients include a decrease in systolic and diastolic functions of the left ventricle, a high incidence of asymptomatic pericarditis, and early myocardial dysfunction. Speckle-tracking echocardiography correlates with biomarkers of arthritis activity. The role of systemic inflammation in the development of non-ischemic heart disease has not yet been adequately studied, although in some studies using MRI and PET-CT, an increase in myocarditis and fibrosis has been revealed. It has not been determined which of the non-ischemic mechanisms of heart failure is more common in patients with rheumatoid arthritis.
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