The Cardio-Rheumatology Clinic Team (from left to right): Shani Nagler (Clinic Assistant), Dr. Dana Jerome (Rheumatologist), Dr. Lihi Eder (Rheumatologist & Co-Director), Dr. Paula Harvey (Cardiologist & Co-Director), Saima Bhatti (Clinic Assistant), Dr. Shadi Akhtari (Cardiologist), Keith Colaco (PhD Student)
The Cardio-Rheumatology Clinic at Women’s College Hospital is Canada’s first Clinic specializing in the early screening and treatment of heart disease in individuals with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis.
- The Cardio-Rheumatology Clinic was established to help those with inflammatory rheumatic conditions manage their heart disease risk.
- Patients undergo a thorough assessment by a cardiologist and are evaluated for abnormal heart function using a variety of advanced imaging and laboratory tests.
- For these reasons, the clinic’s staff are searching for better ways to assess heart risk through its research program.
What does heart disease have to do with my arthritis?
- People with inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, have up to a 50% higher risk of developing heart disease compared to people without inflammatory arthritis.
- Inflammatory arthritis is associated with known risk factors for heart disease, including high blood pressure, diabetes and abnormal cholesterol levels.
- The increased risk of developing heart disease is related in part to these known risk factors, but the severity of inflammation in the joints is also important.
Why do people with inflammatory arthritis develop heart disease?
- Atherosclerosis, the buildup of cholesterol within blood vessel walls (also known as plaques), is the process that leads to the majority of heart diseases.
- Atherosclerosis leads to the narrowing of blood vessels, increased blood pressure and decreased blood flow to the heart and other organs. Some unstable plaques can rupture, triggering a clot that may cause a heart attack or stroke.
- Uncontrolled inflammation, such as in active rheumatoid or psoriatic arthritis, leads to rapid progression of atherosclerosis and increases the risk of plaque rupture.
How to know if you’re at Risk
- Your age and sex as well as information about your blood pressure, blood sugar, cholesterol levels, and lifestyle habits help the physician to estimate your future risk of developing heart disease.
- More advanced tests, like CT and ultrasound of the heart, can improve the accuracy of identifying people who are at high risk of developing heart disease.
- The risk also depends on the severity of inflammation in the skin (for psoriatic arthritis) and joints.
Booking an Appointment
Please note that we currently only accept referrals for individuals with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis. A referral from your rheumatologist or family physician is required. You may ask your physician to complete the patient referral form and have them fax the form to us at 416-323-6115.
The clinic operates on Thursdays from 8:30 am to 4 pm.
What can I expect at my first visit?
When you arrive on the 4th floor, please proceed to check in at the registration desk. Please arrive 30 minutes before your scheduled appointment.
What should I bring with me?
- Completed questionnaire (which will be mailed to you prior to your appointment)
- A list of medications you are currently taking
- A list of doctors and hospitals
- Questions to ask
What will happen during my appointment?
Your first appointment will take approximately 2 hours and will involve:
- A comprehensive assessment by a cardiologist (45mins)
- Electrocardiogram (ECG) (30 minutes)
- After your visit, you will go to the Lobby Lab for a non-fasting blood test
- No preparations are required for your visit, and you do not need to fast for your blood test
After your first appointment, you will need to return to the hospital on another day to complete other imaging tests of your heart. Once we receive the results of these tests, a third visit (20 minutes) will be required to discuss the results of these tests with your cardiologist.
Dr. Shadi Akhtari
Dr. Shadi Akhtari is an associate staff cardiologist at Women’s College Hospital who specializes in advanced cardiac imaging. Dr. Akhtari also runs the weekly cardio-rheumatology clinic at Women’s College Hospital. Apart from clinical practice of general cardiology and multi-modality cardiac imaging, her other areas of interest are prevention, diagnosis, and management of coronary artery disease, particularly in those with underlying rheumatic disease and improving quality of care offered to these patients. Dr. Akhtari graduated from Queen’s University School of Medicine in 2006 and has completed further specialty and subspecialty training in Internal Medicine, Cardiology, and adult echocardiography at McGill University, followed by a fellowship in Cardiovascular Magnetic Resonance Imaging (Level 3 training) at Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, as well as certification in Cardiac Computed Tomography from Johns Hopkins Bayview Medical Center, Baltimore, Maryland.
Dr. Lihi Eder
Dr. Lihi Eder is a Rheumatologist and Clinician Scientist at Women’s College Research Institute and Assistant Professor of Medicine in the Department of Medicine, University of Toronto. Dr. Eder is the Director of the Psoriatic Arthritis Research Program and Co-Director of the Cardio-Rheumatology Ambulatory Program at Women’s College Hospital. Dr. Eder’s research interests are in the area of clinical epidemiology of psoriatic disease and cardiovascular co-morbidities in patients with rheumatic diseases. Dr. Eder is also an expert in musculoskeletal ultrasound and performs research in this field. She serves as the Research Director of the Canadian Rheumatology Ultrasound Society.
Dr. Paula Harvey
Dr. Paula Harvey is Physician-in-Chief at Women’s College Hospital, a scientist at Women’s College Research Institute, and Co-Director of the Cardio-Rheumatology Program at Women’s College Hospital. Dr. Harvey’s research focus is on cardiovascular disease in women, with a special interest in hypertension, lifestyle interventions including cardiac rehabilitation and cardiovascular disease in patients with autoimmune and rheumatologic diseases. Dr. Harvey’s research explores how blood pressure and the health of blood vessels are regulated by the body – and how this system of regulation may differ between women and men. She is also interested in the role of inflammation in autoimmune diseases in the development of cardiovascular disease.
Dr. Elsie Nguyen
Dr. Elsie Nguyen completed her medical school training at the University of Toronto, Radiology Residency at the University of Ottawa, Thoracic Imaging Fellowship at the University of British Columbia in Vancouver followed by a Cardiovascular Imaging Fellowship at Stanford University. She is an Associate Professor at the University of Toronto within the Cardiothoracic Division of Medical Imaging at Toronto General Hospital, Peter Munk Cardiac Centre. She is passionate about education and has been honoured with several teaching awards. She is the Director for Undergraduate Medical Education for Medical Imaging at the University of Toronto. She is also the Director of the Cardiac MRI and CT imaging program at Women's College Hospital. Her research interests include optimization of cardiac CT techniques and calcium score risk prognostication in under-recognized high risk groups, microcoil pre-operative localization of lung nodules, and MR imaging of myocardial iron overload.
There are many resources available for both patients and health care professionals. The following are websites that will provide the answers to many questions you may have about the association between inflammation and arthritis:
Arthritis Foundation: Why People With Arthritis Are at Greater Risk for Heart Disease
National Psoriasis Foundation: Images link psoriasis to other diseases
National Psoriasis Foundation: Don’t ignore cardiovascular risk, researcher urges
Patient Referral Form (.pdf) - FOR PHYSICIANS ONLY -