Cardiovascular Disease in Patients with Rheumatoid Arthritis - Mayo Clinic Grand Rounds
Rheumatoid Arthritis: Minimize Heart Attack Risk
People who have RA face an increased risk for hardening of the arteries, heart attack, and other cardiovascular issues. Learn how rheumatoid arthritis relates to heart health, and how to lower disease risks.
By Madeline R. Vann, MPH
Medically Reviewed by Alexa Meara, MD
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When you have rheumatoid arthritis (RA), you have a greater risk of dying from heart disease. Fatal heart attacks and stroke — another common cardiovascular condition — both cause many premature deaths in people with RA. Add other heart disease risk factors, such as high cholesterol or a family history of heart disease, and the chance you'll have a heart attack or stroke is even greater.
The good news: There's a lot you can do to control heart disease risk when you have rheumatoid arthritis.
The Rheumatoid Arthritis and Heart Disease Link
So why does RA lead to more heart problems? A found that people with rheumatoid arthritis may experience faster rates of hardening of the arteries, or atherosclerosis. Jon T. Giles, MD, MPH, assistant professor of medicine in the division of rheumatology at Columbia University in New York City, led a team that looked at the progression of atherosclerosis in 158 RA patients who'd never had a cardiovascular event, such as a heart attack or stroke. According to Dr. Giles, higher exposure to prednisone in the past was associated with a faster rate of progression. In other words, the more steroids patients had been given, the worse the hardening of the arteries was.
Researchers found thickening of the arteries in most patients. People with RA treated with a class of medication called TNF inhibitors had a slower rate of atherosclerosis progression, as did those taking cholesterol-lowering drugs (statins).
Clues About How RA Contributes to Heart Trouble
The data showed that higher levels of inflammation may predispose people with RA to a greater risk of atherosclerosis and cardiovascular events, says Giles. Also, people with severe symptoms of rheumatoid arthritis (more swollen joints, for example) had greater buildup of plaque in the arteries.
Despite the data pointing to a correlation between RA and heart disease risk, experts are still unsure of the exact mechanism underlying it. The nature of rheumatoid arthritis itself may contribute to the higher risk for heart disease and heart attack.
Inflammation Is a Common Denominator
"Increasingly, we think that chronic inflammation due to RA causes changes in the lining of blood vessels, making it more likely that cholesterol will deposit in the vessel wall," explains Victoria Shanmugam, MD, director of the division of rheumatology and associate professor of medicine at the George Washington University in Washington, DC. "There is also evidence that, for patients with higher levels of inflammation and RA disease activity, cholesterol deposits are more likely to be unstable, leading to increased risk of heart attack."
There's still a lot to understand about the relationship between rheumatoid arthritis and heart disease. Some researchers theorize that the molecules that cause RA (such as cytokines) also contribute to blood vessel damage, but this relationship hasn't been fully defined.
According to the researchers, the common link between rheumatoid arthritis and heart disease may be inflammation. People with RA often have higher levels of markers of inflammation in their blood, such as C-reactive proteins, which the body produces in response to tumor necrosis factor (TNF). Heart disease has been linked to higher levels of these markers, too.
5 Ways to Lower Heart Disease Risk With RA
If you have rheumatoid arthritis and want to reduce your risk of heart problems, here are some ways to swing the balance in your favor:
- Know your heart disease risk. Heart disease is a leading killer, with or without rheumatoid arthritis. If you have RA and heart disease risk factors, such as a family history of heart disease, high cholesterol, high blood pressure, excess weight or obesity, or diabetes, work with your doctor to get them under control.
- Embrace heart-healthy living. Eat a healthy, balanced diet, , and try to get daily exercise. Exercise is also good for your RA, although you might need to check with a physical therapist to make sure you are choosing the best activities. Medication to help control heart disease risk factors, such as drugs for cholesterol, are just as effective for people with RA as it is for those without it.
- Don't ignore heart disease symptoms. People with RA can become so focused on rheumatoid arthritis symptoms that they may ignore other problematic signs, such as .
- Control rheumatoid arthritis. Severe joint pain and out-of-control rheumatoid arthritis symptoms can keep you from following a healthy lifestyle — getting the exercise you need, eating healthfully, and maintaining a healthy weight. Work with your doctor to get RA under control.
- Make wise medication choices. New drugs frequently become available. Because there's a small link between steroids and heart disease risk, it's a good idea to use other classes of medication to control rheumatoid arthritis symptoms if you can.
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