Rheumatoid arthritis is a systemic disease. That means it causes inflammation in not just the joints, but also in other parts of your body such as your internal organs. The organ that commonly get most affected by systemic aspect of RA is your heart. In fact, cardiovascular disease contributes to people with RA on average having a lower life expectancy than the rest of the population - it's called the mortality gap. This is the point where most of us want to stick our heads in the sand and pretend it's not happening. However, as with so many other aspects of RA, educating yourself can help you manage the risk, even improve your heart health and thereby increase your life expectancy. February is American Heart Month - what better time to pop our heads out of the sand and take a look! I spoke to Dr. Lisa Jackson, a cardiologist and expert in prevention from the University of Michigan Health System in Ann Arbor to get more information on this issue.
Taking care of your heart health starts when you're young. Dr. Jackson stated that "it's never too early" to educate yourself about risk factors, including family history of cardiovascular disease, the impact of diet, physical activity, obesity and so on. There are certain aspects of your health that you can monitor to be aware of changes in your body that may put you at risk. High blood pressure and high cholesterol are both risk factors for cardiovascular events. Dr. Jackson said "all 20-year-olds should know what their numbers are." Knowing your numbers when you are healthy allows you to create a baseline of normal. Later in your life you can compare test results to this baseline to see whether there have been changes in your health.
Dr. Jackson recommends that people with RA's "be especially vigilant regarding traditional risk factors. Diabetes, high blood pressure and high cholesterol increase the risk of heart disease."
In addition to systemic inflammation, one possible reason for the mortality gap might be that people with RA don't receive optimal primary care. This may be because RA takes up so much room that other aspects of your health can fall by the wayside. It's important that you be an advocate for yourself and ask your family doctor to regularly check your blood pressure, your cholesterol, sugar, etc. You should also make sure you know the symptoms of a heart attack and know that these symptoms may be different in women. If you experience these symptoms, call 911 immediately.
Heart Tests and RA
The sooner you start the dialogue with your family doctor about the connection between RA and cardiovascular disease, the better. Most family practitioners are not aware of the intricacies of RA and you can do much to help educate them. This will help make them and you more vigilant about paying attention to this part of your health. Discuss when - or if - to start testing your heart to monitor your cardiovascular health. Generally, doctors try not to test just for the sake of testing to avoid false positives. This is when the tests indicate you have a problem, when in reality you don't. When it comes to cardiovascular tests, this can paralyze you with fear and potentially lead to a lot of unnecessary testing.
What happens if you do have symptoms of something wonky with your heart? Many of us know of the infamous stress test during which you're hooked up to machines while you run on a treadmill. According to Dr. Jackson, the treadmill is usually the "first diagnostic test, but echocardiograms are also used to check for blockages and changes in [heart] walls." Echocardiograms are ultrasounds of your heart that require you to lie on your back and half on your side while a technician move the ultrasound wand across your chest.
If your RA affects your ability to run on a treadmill, there are other options. One common alternative is a dobutamine stress echocardiogram. In this test, a drug called dobutamine is administered through an IV. It speeds up your heart, mimicking the effects of exercise. According to Dr. Jackson, once the echocardiogram is done and the medication is stopped, your heart rate returns to normal. Dr. Jackson also mentioned other alternatives to a treadmill stress test, including angiograms and CT scans, such as coronary calcium. Be aware that recent research indicates that a CT scan exposes you to a very high level of radiation and both the American Heart Association and the American College of Cardiolog advise against routine screening involving CT scans.
Managing Heart Disease Risk
One of the most effective tools you have to manage your risk of heart disease is to get your RA treated. Reducing the amount of inflammation in your body will improve your heart health. Studies have shown that the Biologics in particular can cut the risk of heart attack by as much as half and improve outcomes if heart attacks do occur.
Making lifestyle changes can also do much to reduce your risk. Quitting smoking is a huge contributor to making you healthier. Being aware of what you eat is also important. The Western diet with its emphasis on meat and fried foods is notorious for raising heart attack risk. Increasing the amount of fresh fruits and vegetables in your diet and adding soy and tofu can do much to cut your risk.
Maintain a healthy weight isn't just good for your joints, but also for your heart. If you're overweight, talk to your family doctor about how best to approach weight loss. A referral to a nutritionist or dietician may be helpful in this process. Our Diet and Exercise site can also help you with tips for losing weight. Keeping the weight off can be a challenge, especially if you take prednisone, but the benefits to your health can be an excellent motivator.
Being physically active also contributes to improving your heart health. This is not as easy as it sounds when you have RA. Pain and fatigue can put a real damper on your ability to just move around, nevermind getting the heart pumping in a good cardio workout. However, keep in mind that any movement is good - check out Cathy's suggestions for exercise at different levels of disease activity.
This is the third post in a series on preventative health care for people living with RA. See the previous posts on Pap tests and mammograms and endoscopy and colonoscopy. I'll be writing about bone density tests in March.
Lene is the author of the award-winning blog The Seated View