Rheumatoid Arthritis and Increased Heart Disease Risk

Lisa Nelson, RD, LN Health Pro
  • May is Arthritis Awareness Month and I want to discuss the connection between rheumatoid arthritis and heart disease. If you live with rheumatoid arthritis it is even more important for you to be aware of your heart disease risks and take preventive action.


    I've had the pleasure of working with Lene Andersen this month. Lene is the Community Leader for the MyRACentral.com site and took the time to answer a few questions related to rheumatoid arthritis I'd like to share with you.


    Lisa Nelson RD: What is rheumatoid arthritis?


    Lene Andersen: Rheumatoid arthritis (RA) is an autoimmune disease. In autoimmune diseases the person's immune system doesn't work quite right and attacks itself. With RA, this means inflammation in the synovial fluid surrounding the joints and can lead to damage in the joints, which causes deformity and possibly affect long-term mobility. Inflammation can also affect tendons and muscles and - much more rarely - internal organs. For more information, see MyRACentral's section on the basics of RA.

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    Recent development in treatment approaches has led to a significant change in the prognosis of RA. The biologic medications - such as Enbrel, Humira and Orencia - now makes it more possible to bring the disease into remission, which means less damage and deformity.


    Lisa Nelson RD: How is rheumatoid arthritis linked to heart disease?


    Lene Andersen: RA is associated with a "mortality gap," meaning that historically, people who have RA on average have died sooner than the rest of the population. This is primarily due to an increase in ischemic heart disease and hypertension (high blood pressure). Inflammation appears to be a factor in hardening of the arteries, which may explain this phenomenon. As well, some of the medications prescribed for RA - steroids and NSAIDs (onsteroidal anti-inflammatory drugs) - may carry a higher risk of hypertension and heart disease. For instance, in 2004 the anti-inflammatory Vioxx was recalled due to side effects causing a significant increase in heart attack and stroke.


    In addition to the increased risk of heart disease, there are a few other factors that contributed to the mortality gap. People with RA who have heart disease may experience different symptoms than the rest of the population, making it more difficult to diagnose and they also tend to have poorer outcomes after a cardiac event. In addition, people with RA do not receive optimal health maintenance and preventative care services. I'm not sure why this is, although I can speculate that it may be related to preventative care being drowned out by RA-related issues. In other words, the medical team may be so busy focusing on treating inflammation and pain that more routine preventative care falls by the wayside.


    Recent studies indicate that the biologic medications also affect heart health, significantly improving cardiac health and decreasing the mortality gap.


    Lisa Nelson RD: Let me share some standard guidelines for preventative heart care.


    The National Cholesterol Education Program recommends starting at the age of 20 cholesterol lab work every 5 years to monitor cholesterol levels. If you are high risk, such as you use tobacco, are obese, diabetic, hypertensive, or have a family history of heart disease, you may warrant more frequent cholesterol checks. Discuss with your physician to determine appropriate time intervals for your screenings. As an FYI, many medical facilities, health fairs, and employers offer free screenings. Take advantage of the opportunity to be checked!

    The U.S. Department of Health & Human Services recommends blood pressure checks at least every 2 years beginning at the age of 18.

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    Here are links to preventative guidelines for men and women:


    Screen Test Guidelines - Men
    Screening Test Guidelines - Women


    Lene, what would you like to share regarding the importance of being extra vigilant with heart health screening for individuals with rheumatoid arthritis.


    Lene Andersen: When you live with RA, you spend a lot of time in the medical system. Appointments with different doctors, tests, waiting for the results of the tests and it takes up a lot of room. Add to this the fact that people with RA usually have significant issues with fatigue and low energy and it's normal to delay or forget about the rest of your health. However, it's important to remember that RA is really hard on your whole body, not just the joints. Given the increased risk of heart attack and stroke, people with RA should pay extra attention to these areas of their health.


    Lisa Nelson RD: I've read that individuals with rheumatoid arthritis often overlook signs and symptoms of a heart attack. Would you explain why patients with rheumatoid arthritis may not seek care when they have such symptoms?


    Lene Andersen: This is only speculation, but I can imagine a couple of factors influencing such a decision. First, RA comes with a lot of weird symptoms, most of which you learn to ignore - if you went to the emergency room every time your body did something strange, you'd be there several times a week. Secondly, people with RA live with chronic pain, which means you develop a high threshold for pain. Therefore, pain that would alert other people to something being wrong may not register as a problem.


    Lisa Nelson RD: What are preventative steps you recommend for individuals with rheumatoid arthritis?


    Lene Andersen: Advocate for yourself and take control of your medical care. Don't assume your doctor will remember that you need to have checkups at specific times during the year. Book the appointment for your annual physical yourself and remind your doctor of the other types of annual checks that are part of preventative healthcare. As well, due to the impact RA can have on your body, I would recommend that you start these types of preventative healthcare tests about 10 years before people who don't have a chronic illness. That means making a mental note to get a stress test or echocardiogram when you're 35 years old instead of at 45 and follow the same guidelines for colonoscopy, mammogram, prostate test, etc.


    As well, you should also make sure that your diet and lifestyle supports good health. This means eating a balanced diet, staying away from trans fats (and other kinds of fats and sugars) and trying to stay as fit as you can. Exercise can be a challenge when you have RA, so ask your doctor for a referral to a physical therapist who can help you put together an exercise program that will help you get in shape while protecting your joints.


    Lisa Nelson RD: Lene, thank you for taking the time to provide more information on rheumatoid arthritis. Here are a few basic dietary and meal preparation guidelines for individuals living with RA:

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    When you have RA, you may tire easily or have trouble preparing or eating food, depending on the severity of your symptoms. For that reason, some RA patients are at risk for unexpected weight loss or nutrient deficiencies. Following MyPyramid.gov can help assure that you are getting the nutrients you need to stay healthy.


    Eating healthy is not hard. Follow these suggestions:


    • Rely on prewashed and packaged fruits and vegetables, if you can afford these items
    • Purchase deli foods, such as rotisserie chicken
    • Cook double of everything, and eat leftovers a few nights each week
    • Use canned vegetables and beans, but rinse before cooking to remove excess sodium
    • Enjoy sandwiches made with lean meats, such as turkey and ham, adding vegetables such as lettuce, tomato, and cucumber
    • Rely on takeout or frozen meals, if necessary, from time to time
    • Make sure to include fruits and vegetables at each meal, if you can


    It is tempting to think that avoiding some foods can help relieve symptoms of RA. This idea is not a new one, but no evidence exists to prove that foods from the nightshade family (potatoes, tomatoes, eggplant, and sweet and hot peppers, to name a few) make your symptoms worse. Because RA symptoms can wax and wane suddenly and without apparent cause, it is easy to tie them to foods. If you seem to notice a connection to certain foods, you may choose to avoid them. However, use caution when avoiding certain foods, because this could cause you to miss certain nutrients that your body needs for good health.


    Fish oils are part of a class of foods called omega-3 fatty acids. Omega-3s appear to have an effect on the inflammatory response in the body. Some studies have shown an improvement in RA symptoms over the short term with a diet high in omega-3s and/or fish oil supplements. Eating fatty fish, such as salmon, mackerel, herring, and tuna, two times per week is suggested for good health, not just for treatment of RA. Whether taking or not taking fish oil supplements will help is controversial and is not scientifically proven. If you choose to try supplements, watch out for side effects, such as an upset stomach or fishy taste or odor, and remember RA symptoms can come and go quickly. Use caution when deciding whether improvements are linked to your diet or supplements.


    It is possible that future research will show that all omega-3-containing foods can reduce RA symptoms. In addition to fatty fish, other good sources of omega-3s include:


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    Using these foods as part of a healthy diet will not hurt you, and it might just help!


    MyRACentral is celebrating National Arthritis Awareness Month throughout May and will update their Awareness page every week. They will also be holding weekly contests.


    Be sure to sign up for the free e-course 7 Natural Ways to Lower Blood Pressure provided by Health Central dietitian Lisa Nelson at http://lowerbloodpressurewithlisa.com.

Published On: April 27, 2011