Established in 2017 by Dr. Lihi Eder and Dr. Paula Harvey, the University of Toronto Cardio-Rheumatology Network is a collaboration among clinicians and scientists within the University of Toronto, Toronto, Canada, with the aim of improving primary prevention of cardiovascular events in patients with rheumatic diseases by developing novel approaches to cardiovascular risk stratification.

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Our Vision:

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Through a coordinated care and research network involving patients, clinicians, and scientists, we hope to address the unmet clinical and research needs, to identify early atherosclerosis in patients with rheumatic disease, and to improve the health outcomes of this patient population.

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Aims:

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• Improve the primary prevention of cardiovascular events in individuals with rheumatic diseases

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• Develop novel approaches to cardiovascular risk stratification using traditional risk factors, laboratory biomarkers and cardiovascular imaging

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• Work in partnership with patients and other knowledge users to listen, understand and respond to their health priorities

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• Collaborate widely to maximize the value of our research and support others in theirs  

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Why Study Cardio-Rheumatology?

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The notion that inflammation has deleterious effects on the arteries and the heart and that our rheumatic patients are at high risk for developing cardiovascular events is now well accepted in the rheumatology community. However, there are many gaps in knowledge regarding the underlying mechanisms of cardiovascular diseases in rheumatic patients, which lead to varying and conflicting recommendations for the management of cardiovascular risk in these patients. Standard clinical risk-assessment tools which take into account traditional cardiovascular risk factors underestimate cardiovascular risk in patients with inflammatory rheumatic conditions. There is a need for development of more accurate tools to assess cardiovascular risk in this population.

 

Gaps in Patient Care

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Additionally, significant gaps in care exist in the management of cardiovascular risk factors in patients with rheumatic diseases. Specifically:

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• Awareness of the increased cardiovascular risk among rheumatologists has not translated into adherence to treatment recommendations.

• A significant proportion of patients have undiagnosed and undertreated cardiovascular risk factors.

 

These gaps in care may be explained by the fact that, understandably, visits with rheumatologists are spent addressing the management of the actual rheumatic condition, leaving little time and attention to primary prevention of cardiovascular events. This is potentially compounded by the fact that many family physicians and even cardiologists may not be aware of the increased cardiovascular risk in these patients. Limited knowledge about cardiovascular prevention strategies and disagreement in the rheumatology community about the role of specialists versus family doctors in the management of cardiovascular risk factors are some of the potential additional reasons for this gap in care.

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Cardio-Rheumatology Clinic at Women's College Hospital

 

The Women’s College Hospital Cardio-Rheumatology Clinic was established in July 2017 as part of a wider collaborative Cardio-Rheumatology network within the University of Toronto that also involves physicians from Mount Sinai Hospital led by Dr. Bindee Kuriya. The program is led by Dr. Lihi Eder, staff rheumatologist and scientist at Women’s College Research Institute and Dr. Paula Harvey, cardiologist and Chief of Medicine at Women’s College Hospital. Together with Dr. Shadi Akhtari, a cardiologist, who runs the weekly cardio-rheum clinic, the team has set a goal to improve the management of cardiovascular risk in patients with rheumatic diseases.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Paula Harvey has been involved in the field of cardio-rheumatology since coming to Canada in 1999 from Australia to do her post-doctoral research, which evolved from her special interest in studying cardiovascular disease in women. This interest led to a close clinical and research collaboration with the University of Toronto Lupus Program. Lihi Eder’s interest in cardiovascular morbidity in rheumatic diseases evolved during her post-doctoral fellowship at the University of Toronto Psoriatic Arthritis Program, where she investigated the effect of biologic medications on atherosclerosis progression in patients with psoriatic disease. Their shared interest in cardiovascular medicine in rheumatic patients led to the establishment of this collaborative network.

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