Abstract
BACKGROUND AND OBJECTIVE: Rheumatoid arthritis (RA) is a chronic, autoimmune disease primarily influencing the synovial joints resulting in joint destruction. Systemic manifestations associated with RA have been implicated with recent evidence suggesting a pertinent role of RA in cardiovascular health. Epicardial adipose tissue (EAT), the layer of fat surrounding the heart, has been found to be an emerging diagnostic marker for cardiovascular conditions associated with RA given its role in proinflammatory cytokine release. However, given the novelty of EAT, its utility required further appraisal. This review aims to evaluate the role of EAT as a diagnostic and prognostic marker for cardiovascular involvement in RA and to explore its potential as a therapeutic target to mitigate cardiometabolic risk. METHODS: PubMed and EMBASE were searched from July to October 2024 yielding relevant studies that examined the role of EAT as a clinical tool for RA associated cardiometabolic diseases. KEY CONTENT AND FINDINGS: Evidence has implicated greater EAT thickness and higher disease activity in RA. Elevated levels of adipokines, secreted by the adipose tissue, and found in association with EAT, play a key role in regulating inflammatory diseases such as RA. Since EAT could be promoting atherosclerosis, it could be a useful tool for early identification of cardiovascular conditions in RA and anti-inflammatory therapies controlling systemic inflammation may indirectly reduce EAT. CONCLUSIONS: Given the clinical modifiability of EAT, it holds promise as a viable risk stratification tool and as a potential therapeutic target for reducing cardiovascular complications in RA.