Today is National Go Red Day to raise awareness of heart disease in women. As women living with RA, this is especially relevant to us.
RA is a systemic disease that doesn't just affect joints, but also other systems of the body. This includes tendons, the vascular system, and internal organs such as the heart. The inflammation of untreated RA can impact all of these systems. In joints, inflammation can cause damage and deformity. In the heart, inflammation can cause heart disease.
RA and the mortality gap
Historically, people who have RA also have what is called a "mortality gap," having an approximately ten year shorter life expectancy than the general population, partly because of the higher risk of heart attack and stroke.
In the last 15 years, the mortality gap has been shrinking. When Biologics came on the market, more people than ever before experience remission or low disease activity. This keeps joints from becoming damaged and also reduces the impact of inflammation on the heart. Some studies of TNF blockers show that the longer your disease is treated, the lower your risk of heart disease.
When I first learned of the mortality gap five or six years ago, I was shocked. Finding out that I live with a disease that can shorten my life span was very scary. None of the rheumatologists I've had in my 40+ years of living with the disease have ever discussed the systemic impact of RA with me or suggested I see a cardiologist for preventative care.
Others in the RA community share my experience. Even now, all these years later, many rheumatologists focus on the joints and leave the coordinating of other care to your primary care physician. This assumes that GPs know enough about RA to refer you to a cardiologist and most don't. Instead, they rely on your rheumatologist to deal with issues related to your RA. While they circle around each other in this never-ending loop, your care falls through the cracks. In fact, another factor that contributes to the mortality gap is issues such as this that prevents people with RA from getting the primary care we need.
Symptoms of heart attack in women
Six months ago, I was taken to the ER in an ambulance after an ECG at my family doctor's office showed I'd had a heart attack. I went to see her after experiencing symptoms that I knew could indicate a heart attack.
Most of us are aware of the classic sign of a heart attack: pain in the chest that goes out into the left arm. However, women who have a heart attack may not experience that at all. Instead they can have symptoms of nausea, diarrhea, jaw pain, sweating, pressure in the chest, back pain, and lightheadedness.
Of course, the symptoms may also be signs of a number of other things, such as stress, stomach flu, GERD, and sitting too long in the wrong position. How do you know when you should act? Trust you gut. According to the American Heart Association, 90 percent of women who've had a heart attack had a feeling it was their heart.
If you have any of these symptoms, or the more classic signs, call 911. Don't drive yourself. If you get worse or lose consciousness, you could hurt someone else. Taking a cab is not a good idea, either a taxi driver doesn't know how to save your life. Paramedics do.
I went to see my doctor because I had too many symptoms at the same time. Although I'd experienced the individual symptoms separately, something told me it was best to get checked when they all happened at once. I had pressure in the chest, back pain, felt weak (especially in my left arm), was nauseated and lightheaded. Thankfully, testing at the ER showed that I had not had a heart attack after all the ER doctor told me it was a particularly nasty case of GERD.
Still, I'm glad I went. I'd rather go to the ER one too many times with indigestion, than one too few with an actual heart attack.
Preventing heart disease
Information is power. Knowing that RA can have an impact on your heart health allows you start managing that risk.
One of the best things you can do for your heart is to get your RA treated. Reducing the inflammation in your body will make your heart healthier.
It's also a good idea to start talking to both your family doctor and your rheumatologist about the systemic impact of RA. Ask for a referral to a preventative cardiologist. They can develop strategies to reduce the risk of heart attack and stroke.
Educate yourself about how to improve your heart health and follow through on the information. Be as physically active as you can. Getting a referral to physical therapist can help you find ways to exercise without putting a strain on your joints. Eating a heart healthy diet, drinking only moderately and you know this one quitting smoking can all contribute to you getting healthier and reducing the risk of heart attack.
Did you know about the connection between RA and heart disease? What's your experience with improving your heart health?
See More Helpful Articles:
Closing the Mortality Gap: RA and Heart Disease
RA and Preventative Health Screening: Heart
8 Facts about RA and Heart Disease
A Beginner's Guide to RA: Biologics
Remission in RA: An Interview with Dr. Yusuf Yazici
Lene writes the award-winning blog The Seated View. She's the author ofYour Life with Rheumatoid Arthritis: Tools for Managing Treatment, Side Effects and Pain and 7 Facets: A Meditation on Pain.