Meet Dr. Bindee Kuriya: Helping rheumatic disease patients with matters of the heart (by Laurie Proulx)

Early in her career, Dr. Bindee Kuriya noticed that many people with rheumatic diseases were experiencing cardiovascular issues – known today to be caused by systemic inflammation in these people. For example, some had arthrosclerosis (hardening of the arteries), stroke, and heart attack. “I knew that rheumatic diseases were more than just tender and swollen joints – it was a whole person disease“ says Dr. Kuriya. This inspired her to pursue better ways to deliver care to patients in addition to focusing research on rheumatic diseases and cardiovascular diseases (CVD).

Dr. Kuriya is a rheumatologist at Mount Sinai Hospital and Assistant Professor at the University of Toronto (U of T) Institute of Health Policy, Management, and Evaluation.  She is a clinician-investigator which means she spends half her time seeing people with rheumatic diseases and the other half doing research. She is the principal member of the Cardio Rheum Program at U of T that is aimed at primary prevention of CVD for people with inflammatory arthritis. This clinic involves multiple specialists that screen and treat people with rheumatic diseases for cardiovascular disease. A typical visit involves taking a history to identify risk factors, physical exam, screening for diabetes, identifying height and weight and some testing, like a coronary artery calcification scan and/or ultrasound of the heart. Dr. Kuriya notes: “The focus of the rheumatologist is to treat systemic inflammation while the cardiologist is assessing cardiovascular risk and treating diabetes.” She notes that the cumulative inflammation that someone with rheumatic disease has experienced throughout their life can affect the risk of CVD.

Dr. Kuriya also spearheads a research program asking questions like – what is the prevalence of risk factors in people with rheumatoid arthritis? What are the preferences of people with rheumatic diseases when it comes to CVD disease screening and management?  What is the role of medications and cardiovascular disease? Dr. Kuriya’s latest research study found that up to 40% of patients are eligible for cholesterol lowering medication but aren’t on a medication. She notes that it’s important for rheumatologists to work with family physicians since screening for cardiovascular risk factors is one of their usual responsibilities (though cardiologists can also play a role). In 2021, the Canadian Cardiology Society updated the Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in Adults to note that people with inflammatory disease (e.g. Rheumatoid Arthritis, Systemic Lupus Erythematosus, Psoriatic Arthritis, Ankylosing Spondylitis) of any age should be screened.

What can patients do to address heart health issues? Dr. Kuriya notes: “When inflammation is controlled then the risk of heart disease goes down. We need to do everything we can to control Rheumatoid Arthritis and ideally achieve remission or low disease activity.” She also says that patients should be empowered to ask their family doctors for cardiovascular screening and have blood pressure, cholesterol and weight checked. It is also important to control risk factors, like reduce or stop smoking and manage weight.  Dr. Kuriya notes the value of exercise, and that people should feel “winded” or out of breath and can consider simple things like walking at a brisk pace, low impact exercise, and swimming.

In reflecting on our conversation, I hope that we see more leadership and changes in health care across Canada to ensure cardiovascular disease is an ongoing consideration in managing rheumatic diseases. Dr. Kuriya is making a difference and helping rheumatic disease patients with matters of the heart.

Download this document in PDF