Here’s Why Having RA Increases Your Heart-Disease Risk
These conditions share more in common than you might think. The culprit? Chronic inflammation.
You probably wouldn’t guess that rheumatoid arthritis (RA) and heart disease share much in common. On the surface, they seem like very different chronic conditions—one primarily affects your joints, the other your arteries, veins, and heart.
But take a closer look at the research, and you’ll find something surprising: RA patients have a 50% to 70% higher risk of heart disease than the general population, according to the Arthritis Foundation. This connection has been noted and studied in publications like RMD Open and the American Heart Journal.
“When you think about the risk factors for having a heart attack, [you think about] high cholesterol, family history, sedentary lifestyle, obesity, diabetes, and smoking,” says Eric Ruderman, M.D., professor of medicine and associate chief of clinical affairs in the division of rheumatology at Northwestern University Feinberg School of Medicine in Chicago. “Now it’s pretty clear that you can add systemic inflammatory diseases like rheumatoid arthritis to that list.”
What’s behind this unlikely relationship? Experts say it has to do with chronic inflammation.
Inflammation & Your Body
RA is an autoimmune disease that occurs when your immune system attacks the linings of otherwise healthy joints. It causes inflammation in areas like your hands, knees, and ankles, though it can also extend to other parts of the body. Dr. Ruderman notes that when inflammation spreads, it can impact multiple organ systems—including your blood vessels and heart. “When you have a disease that causes systemic inflammation, be it RA or psoriatic arthritis [or another condition], that inflammation seems to increase risk of inflammation in your vessels that can lead to the consequences of coronary artery disease,” he notes.
When your vessels become inflamed, that raises a red flag. Research has shown that inflammation can lead to atherosclerosis, a.k.a. plaque build up in the arteries of the heart —a telltale sign of heart disease. “Inflammation plays an important role in cardiovascular disease in general,” explains David Pisetsky, M.D., Ph.D., professor of medicine and immunology at Duke University Medical Center in Durham, NC, and past president of the United States Bone & Joint Initiative. “So, one might expect that people who have higher burden of inflammation systemically would have more cardiovascular problems.”
Medication Helps Lower Your Risk
Perhaps even more important than knowing this RA/heart disease connection is understanding how medications and disease management can help change your inflammatory markers. A new study in Annals of Rheumatic Diseases shows that disease modifying anti-rheumatic drugs (DMARDs) used for early RA can help improve cardiovascular outcomes. This builds upon previous research—methotrexate, for instance, has been shown to help reduce cardiovascular-disease risk.
Dr. Ruderman explains that this is (again) likely related to inflammation. “It’s not the medicine that’s affecting the heart disease, it’s the medicine that’s treating the rheumatoid arthritis and reducing inflammation,” he says. “The consequence of that is that the factors around rheumatoid arthritis that drive that increased risk of heart disease are reduced.”
The same result has been shown with TNF inhibitors, a type of biologic. A study in the International Journal of Molecular Sciences noted that the anti-inflammatory effects of anti-TNF treatment can sometimes help improve cardiac function in RA patients.
What’s still unclear, Dr. Pisetsky notes, is which RA drugs are best for reducing cardiovascular risk and which might be doing harm. Nonsteroidal anti-inflammatory drugs (NSAIDs), which are also a common treatment option treatment option for many RA patients, have been shown to increase the risk of heart attack and stroke.
“Cardiovascular risk exists [with NSAIDs], but it’s sometimes hard to know how big it is,” he says. If someone takes these drugs on an everyday basis, there might be an argument for switching to a different form of treatment.
Both doctors note, however, that much research still needs to be done. There isn’t clear evidence to support RA patients taking one particular drug for their heart health at the expense of other medications. If you’re concerned about your risk or a loved one’s risk, bring this up with your doctor to get their advice. But the bottom line is this: Whatever medicine is best for controlling your RA activity may ultimately also help with your heart disease risk.
Protecting Your Heart
There’s a lot you can do day-to-day to reduce bodily inflammation, which bodes well for not only your joints but also your heart. “If you look at a group of rheumatoid arthritis patients who have really active disease, and [those who] have disease that’s well-controlled or in remission, there’s a big difference in their risk of heart attack and stroke,” Dr. Ruderman says.
First and foremost, get your disease under control as soon as you can. (That’s where the proper medicine comes into play!) “Continue to modify your treatment until the disease is in remission,” Dr. Ruderman says. That might mean changing up your medications until you find something that works well for you. RA can take a while to treat due to trial-and-error in figuring out a treatment plan but sticking with it pays off for your health in the long run.
Think about the risk factors (for RA and heart disease) you do have control over. “You can’t change your genetics,” Dr. Ruderman says, “but if you smoke, you can certainly stop smoking. If you’re overweight and sedentary, you can do something about that. If you have high cholesterol, there’s diet and medication for that.” RA lifestyle changes like exercise, better sleep, and a whole-foods diet have been shown to reduce inflammation and limit RA flares. And guess what: These are the same lifestyle changes that can reduce your risk for cardiovascular complications.
Everyone should be concerned about heart disease, but RA patients in particular should be diligent about managing their risks. Know the warning signs of a heart attack, which are different for women and men, is key. “If you have RA, your risk of heart disease is higher,” Dr. Ruderman notes. “It becomes even more important than it would for anybody else to make sure you modify all the other risks you can modify.” If you’re just now recognizing the need to make these changes, don’t sweat—it’s never too late to start.
RA Risk Factors: Centers for Disease Control and Prevention. (n.d.) “Rheumatoid Arthritis (RA).” cdc.gov/arthritis/basics/rheumatoid-arthritis.html
RA Symptoms: Arthritis Foundation. (n.d.) “Rheumatoid Arthritis.” arthritis.org/diseases/rheumatoid-arthritis
RA & Heart Disease Prevalence: Arthritis Foundation. (n.d.) “Arthritis and Heart Disease.” arthritis.org/health-wellness/about-arthritis/related-conditions/other-diseases/arthritis-and-heart-disease
RA & Heart Disease Study: RMD Open. (2020.) “Risk of major adverse cardiovascular events among patients with rheumatoid arthritis after initial CT-based diagnosis and treatment.” rmdopen.bmj.com/content/6/1/e001113.long
RA & Cardiovascular Risk: American Heart Journal. (2013.) “Rheumatoid Arthritis and Cardiovascular Disease.” ncbi.nlm.nih.gov/pmc/articles/PMC3890244/
Inflammation & Heart Disease: Nature Reviews Cardiology. (2016.) “Inflammatory processes in cardiovascular disease: a route to targeted therapies.” nature.com/articles/nrcardio.2016.185
DMARDs Cardiovascular Effects: Annals of the Rheumatic Diseases. (2020.) “Cardiovascular effects of biological versus conventional synthetic disease-modifying antirheumatic drug therapy in treatment-naïve, early rheumatoid arthritis.” ard.bmj.com/content/early/2020/08/28/annrheumdis-2020-217653
Methotrexate Cardiovascular Effects: Therapeutic Advances in Musculoskeletal Disease. (2012.) “Protective effect of methotrexate in patients with rheumatoid arthritis and cardiovascular comorbidity.” ncbi.nlm.nih.gov/pmc/articles/PMC3400102/
TNF Inhibitors Cardiovascular Effects: International Journal of Molecular Sciences. (2018.) “Bimodal Function of Anti-TNF Treatment: Shall We Be Concerned about Anti-TNF Treatment in Patients with Rheumatoid Arthritis and Heart Failure?” ncbi.nlm.nih.gov/pmc/articles/PMC6032136/
NSAIDs & Heart Health: Cureus. (2017.) “Cardiovascular Risk of Nonsteroidal Anti-Inflammatory Drugs: An Under-Recognized Public Health Issue.” ncbi.nlm.nih.gov/pmc/articles/PMC5422108/