Rheumatoid Arthritis and Cardiovascular Disease

by Lisa Emrich Patient Advocate

Do patients with RA have an increased risk of developing heart disease?

In a previous post, Is there a link between Rheumatoid Arthritis and Diabetes?, I referenced a study which compared risk factors for cardiovascular disease in patients with RA versus diabetes.
The result of this study indicates that patients with RA have 2-3 times the risk of atherosclerosis (specifically coronary artery disease) as compared to healthy controls.
A similar study confirms these results; see "Atherosclerosis in Rheumatoid Arthritis Versus Diabetes: A Comparative Study."

What does cardiovascular disease look like in rheumatoid arthritis?

The chronic inflammation which damages joints also takes its toll on the heart and arteries.
The doctors at Johns Hopkins provide a summary of recent studies focused on RA and heart disease.
Compared to the general population, rheumatoid arthritis patients have a significantly increased risk of heart attack and stroke and a shorter life expectancy.

- Heart attacks are twice as common among women with rheumatoid arthritis as among those without the disease.

- Atherosclerosis ("hardening of the arteries") starts early and progresses more rapidly in people with rheumatoid arthritis.

- Carotid artery blockages (a risk factor for stroke) are three times more common in people with rheumatoid arthritis than in people without the disease (44% vs. 15%).

- Cardiovascular events, such as heart attack and stroke, occur about 10 years earlier in people with rheumatoid arthritis.

- Mortality is higher among rheumatoid arthritis patients after a first heart attack.

- Blood vessel damage is often already apparent at the time of rheumatoid arthritis diagnosis.

- Heart attacks in rheumatoid arthritis patients are more likely to be silent or to occur without the typical symptoms, and they more often result in sudden cardiac death.

- Congestive heart failure (weakening of the heart's pumping ability) is more common among people with rheumatoid arthritis.

Accumulating immune system cells (caused by chronic inflammation) attract deposits of cholesterol, blood platelets, cellular debris, and calcium, which clump together to form plaque. As plaque deposits grow, they restrict blood flow through the artery. If the plaque ruptures, clots can break away and travel to the heart or brain, where they may cause a heart attack or a stroke.

Can a person with rheumatoid arthritis decrease their risks of heart disease?

The medical community is calling for more awareness of the connection between rheumatoid arthritis and cardiovascular disease. Once you have cardiovascular disease (CVD), it significantly impacts your quality of life and cuts your life expectancy. Although there are few guidelines for preventing heart disease when you have rheumatoid arthritis, following these general pointers to reduce CVD risk can make a difference.

- Control inflammation. The inflammation caused by rheumatoid arthritis that contributes to atherosclerosis, or the buildup of plaque in your arteries. When the arteries become clogged, clots form and you can suffer a heart attack or stroke.

- Cut your fat intake. Avoid using products containing trans, hydrogenated or saturated fat, such as margarine, shortening, butter, and processed or packaged foods. Use healthy oils such as olive oil, especially extra virgin olive oil, almond oil, and sesame oil.

- Eat fatty fish. Research shows that fish high in omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), provide several heart benefits. According to the American Heart Association (AHA), omega-3 fatty acids decreased triglyceride levels and growth rate of atherosclerotic plaque, decresed the risk of arrhythmias, which lead to sudden cardiac death and slightly lowered high blood pressure.

The AHA recommends eating fatty fish such as albacore tuna, herring, trout or salmon at least twice a week. Soybeans, canola, walnuts and flaxseeds contain alpha-linolenic acid which breaks converts into omega-3 fatty acids in your body. You can also take EPA and DHA in capsule form under medical supervision.

- Exercise regularly. Physical activity relieves inflammation and other symptoms of rheumatoid arthritis - and boosts cardiovascular health. Just 30 minutes of exercise a day, five days a week, can lower hypertension and cholesterol levels when you have RA, states the Arthritis Foundation.

Stick to (or increase) your therapeutic exercises. Also, add aerobic, strength-training, and meditative exercises to your routine. Always get advice from your rheumatologist and physical therapist before starting an exercise plan.

- Maintain a healthy body weight and manage stress levels.
Obesity is a key risk factor for heart disease and even a 5-10% weight reduction is beneficial for your joints and your heart.

- Quit smoking. Cigarette smoking is one of the leading causes of heart disease. It increases blood pressure and the tendency for blood to clot, and decreases good cholesterol and exercise, states the AHA. It's one of the major factors in atherosclerosis or the buildup of fatty tissue in the arteries. Studies also show that cigarette smoking increases levels of inflammatory markers, such as C-reactive protein and white blood cell count. The inflammation-causing substances contribute to atherosclerosis as well.

- Cut out salt. High sodium intake increases your blood pressure, which increases the risk of heart disease. The AHA advises most people to eat less than 2,300 mg of salt per day. However, if you are African American, middle-aged or older, or already have high blood pressure, aim for less than 1,500 mg per day. Most prepared foods contain high sodium levels, so be sure to read labels. Also, use spices when you're cooking for flavor, instead of salt.

- Talk to your doctor.
Get regular medical checkups and heart disease screening tests for high blood pressure, blood sugars, and high cholesterol. Have an electrocardiogram.
Talk to your doctor about your health history and your family history of heart disease.

What are the signs and symptoms of a heart attack?

Some heart attacks are sudden and intense - the "movie heart attack" - and no one doubts what's happening. But most heart attacks start slowly, with mild pain or discomfort. Often people affected are not sure what's wrong and wait too long before getting help. Here are warning signs that can mean a heart attack is happening:

- Chest discomfort.

Most heart attacks involve discomfort in the center of the chest that lasts more than a few minutes, or that goes away and comes back. It can feel like uncomfortable pressure, squeezing, fullness or pain.
- Discomfort in other areas of the upper body.

Symptoms can include pain or discomfort in one or both arms, the back, neck, jaw or stomach.
- Shortness of breath.

This may occur before, with or without chest discomfort.
- Other signs.

These may include breaking out in a cold sweat, or experiencing nausea or lightheadedness.

Learn the signs. Even if you're not sure it's a heart attack, have it checked out. Minutes matter. Fast action can save lives maybe your own. Do not wait more than five minutes to call 911.

For More Information: Rheumatoid Arthritis and Heart Disease, Arthritis Foundation.

Rheumatoid arthritis is an independent risk factor for multi-vessel coronary artery disease: a case control study.
Warrington KJ, Kent PD, et al.
Arthritis Research & Therapy. 2005; 7(5): R984-R991.

The inextricable link between atherosclerosis and prototypical inflammatory diseases rheumatoid arthritis and systemic lupus erythematosus. Full LE, Ruisanchez C, Monaco C. Arthritis Research & Therapy. 2009; 11(2): 217.

Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study. Naranjo A, Sokka T, the QUEST-RA Group, et al. Arthritis Research & Therapy. 2008; 10(2): R30.

Tackling ischaemic heart disease in rheumatoid arthritis. Kitas GD, Erb N. Rheumatology. 2003; 42: 607-613.

Lisa Emrich
Meet Our Writer
Lisa Emrich

Living with multiple sclerosis and rheumatoid Arthritis, Lisa Emrich is an award-winning, passionate patient advocate, health writer, classical musician, and backroad cyclist. Her stories inspire others to live better and stay active. Lisa is author of the blog Brass and Ivory: Life with MS and RA and founder of the Carnival of MS Bloggers. Lisa frequently works with organizations in support of better policies, patient-centered research, and research funding. Lisa serves on HealthCentral’s Health Advocates Advisory Board, and is a Social Ambassador for the MSHealthCentral Facebook page.