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Patients with rheumatoid arthritis (RA) have a significantly higher risk of coronary heart disease, despite being less likely to report symptoms of angina, and are more likely to experience unrecognised myocardial infarction and sudden cardiac death than non-RA controls.1 Furthermore, left ventricular diastolic dysfunction has been described in up to 40% of patients with RA.2
Traditional risk factors partially account for this increased risk, and primary prevention is important in this high risk group. Electrocardiography (with or without stress testing) and echocardiography are commonly requested investigations to detect underlying cardiac disease, but access, particularly to echocardiography, is mostly limited to those who are symptomatic. Brain natriuretic peptide (BNP) is a new cardiac biomarker, which is increased in ventricular dysfunction, both systolic and diastolic, …