Effectiveness of liver function tests in screening for cardiovascular risk in rheumatoid and psoriatic arthritis patients
Authors: Gonzalez-Melendez A , Polina-Lugo R , Elizondo-Benitez M F , Guajardo-Aldaco A L , Cardenas-De La Garza J A , Colunga-Pedraza I J , Galarza-Delgado D A , Azpiri-Lopez J R , Arvizu-Rivera R I , Gonzalez-Gonzalez V , Cardoso-Casco D I , Salcedo-Almanza D A 
Published: January 2025

Abstract

Background
Liver tests are used to evaluate liver damage due to medication and have gained attention for their potential role in assessing cardiovascular risk (CVR) in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA). In the general population, studies suggest that serum gamma-glutamyl transpeptidase (GGT) levels correlate with endothelial dysfunction and left ventricular (LV) alterations, leading to a higher risk of cardiovascular events. In contrast, serum bilirubin (SB), a byproduct of heme metabolism known for its antioxidant and anti-inflammatory properties, shows potential protective effects.

Purpose
To associate SB levels with carotid plaque prevalence and GGT levels with LV alterations in RA and PsA patients.

Methods
We conducted a cross-sectional study involving RA and PsA patients aged 40 to 75 who met the 2010 ACR/EULAR and 2006 CASPAR criteria, respectively. Patients with previous cardiovascular disease, pregnancy, overlap syndrome, renal or hepatic dysfunction were excluded. A carotid ultrasound and transthoracic echocardiograms were performed on all participants. CP was defined as a diffuse carotid intima-media thickness (cIMT) ≥1.2 mm or focal thickness ≥0.5 mm. The echocardiographic evaluation included left ventricle mass index (LVMI), relative wall thickness (RWT), mitral deceleration time (MDT), E/E mitral ratio, E/A mitral ratio, tricuspid annular plane systolic excursion (TAPSE), and left ventricular ejection fraction (LVEF). Subclinical LV systolic dysfunction was defined as a global longitudinal strain (GLS) greater than -18%. The Kolmogorov–Smirnov test was employed to determine normality. Comparisons with Chi-square, T-, or U-Mann Whitney test, accordingly. A p-value of ≤0.05 was considered statistically significant.

Results
A total of 51 patients were included 25 with RA and 26 with PsA. Patients were divided into two groups based on the presence of carotid plaque and according to GGT levels, with ≥28 U/L considered high. Most were women (n= 40, 78.4%) and had similar CVR factors (Tables 1 and 2). CP was found in 52.9% (n=27) of the patients and these had more prevalence of dyslipidemia (66.6% vs 50%, p=0.227), as well as higher SB levels. Conversely, patients with lower GGT levels exhibited greater remodeling characteristics, although there was no statistically significant difference in either case. A slightly higher prevalence of subclinical systolic dysfunction was observed in the high GGT group (66.6% vs 60%, p=0.25).

Conclusion
Our study found that SB levels are neither a protective factor against subclinical atherosclerosis nor an association between GGT levels and LV alterations in RA or PsA patients. Therefore, larger sample sizes are necessary to evaluate the effectiveness of the liver profile as a predictor of CVR and the detection of echocardiographic alterations. Carotid ultrasound and echocardiographic assessments should be included in a comprehensive cardiovascular evaluation.