RA and Heart Disease

In addition to your joints, the inflammatory effects of RA can spread to organs throughout the body, including your heart. Having RA increases your chance of developing heart disease. In fact, it's the leading cause of death for those of us with RA. Many people just aren't aware of the link between RA and their heart. I know I wasn't. Understanding the nature and level of risk can help provide the tools we need to improve outcomes.

The number one cause of premature death in people with RA is cardiovascular disease. So the link between the two is very serious. There are a number of potential ways it can show up. Probably among the most common and most feared is a heart attack. But certainly, stroke can occur as well.

The overall risk of cardiovascular disease doubles in patients with RA as compared to the general population. This includes a 50% increased risk of heart attack and a doubling of the risk of stroke and congestive heart failure.

Patients who have RA appear to have a level of risk comparable to a person 10 years older. Evidence also suggests that younger women have a more pronounced risk than might be expected.

The connection between RA and heart disease may seem like a mystery at first. It's probably one reason why people who have RA are not necessarily thinking about being at greater risk of something like a heart attack. What, really, is the link between your joints and heart?

The shared link between the joints and cardiovascular system in rheumatoid arthritis is simple, inflammation. RA is, basically, an inflammatory disorder.

Now, your immune system mistakenly identifies healthy tissue in the lining of the synovium around the joints as a foreign entity and attacks it. And that causes inflammation and pain. It's believed that the same inflammatory processes involved in RA also damage parts of the cardiovascular system, including the endothelial lining of the blood vessels. This damage or injury encourages the development of plaque, which is unstable and can break off, leading to the formation of a blood clot that can block an artery to your heart or your brain, resulting in either a heart attack or a stroke. Various pathways are involved. And the process is extremely complex. But that would be the basic underlying connection.

Having RA alone doesn't mean you're destined to develop heart disease. Lots of other factors, including lifestyle, also play a role. Let's examine them to get a better idea how to prevent negative outcomes.

The mechanisms and risk factors that fuel rheumatoid arthritis and its ongoing inflammation are also shared with cardiovascular disease. Smoking and obesity, for example, are strong risk factors for RA, and also for cardiovascular disease. The lack of activity that often accompanies RA because of joint pain is, likewise, a cardiovascular risk factor.

All these factors that play a role in the development or severity of RA can also come together to accelerate the chance of heart disease. The good news is that they can be prevented.

We're not destined to have heart troubles just because of RA. There are lots of things one can do that have a positive impact not only on RA, but your overall health as well.

The place to start lies in taking control of rheumatoid arthritis itself. There's good evidence showing that keeping tight control over RA inflammation and disease activity also reduces the risk of heart attack and stroke. The longer you are in remission, the lower the odds of having a cardiovascular event.

Some DMARDs, such as methotrexate, appear to have a protective effect. Tumor necrosis factor inhibitors also protect the heart by reducing inflammation in the body. On the flip side, corticosteroids and nonsteroidal anti-inflammatory drugs that may be used to reduce pain or inflammation may increase cardiovascular risk. Modifying lifestyle factors, such as diet, weight, exercise, and smoking, all can have a very positive impact on RA as well as on cardiovascular health.

When you have RA, your heart deserves special attention. With the right screening and preventative measures, you can keep your heart and blood vessels healthy. Don't be afraid to raise the issue with your rheumatologist as well as primary care provider. Ask them for answers about your risk and what you can do to improve it.

ALLAN GIBOFSKY: Although many rheumatologists are interested in the connection between RA and cardiovascular disease, managing complex chronic conditions, such as the heart and blood vessels, is still mainly the domain of your primary care physician and cardiologist. They can help you manage the various risk and lifestyle factors that come into play.

An evaluation of cardiovascular health should include, among other things, regular testing of blood pressure, blood sugar, and cholesterol levels. The European Alliance of Associations for Rheumatology recommends cardiovascular screening at least once every five years and every time an RA medication has changed. Stress test, electrocardiogram, or echocardiogram may be performed, as needed. One should be vigilant for symptoms of heart disease, such as shortness of breath, chest pain, or arm pain, and report them to a physician immediately.

One way to reduce the risk of heart disease and bad outcomes from RA is through aggressive treatment. In recent years, there's been a revolution in DMARDs available to treat RA, driven largely by biologic therapies. Join me next time, when we take a closer look at this newer class of agents.