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Heart disease is a catch-all term that includes heart attack, irregular heartbeat, high blood pressure and atherosclerosis (the build-up of plaque in the arteries). Heart disease is the leading cause of death in rheumatoid arthritis (RA) patients, and if you have RA, you have a twofold increased risk for heart attack and stroke. For people who’ve had RA for 10 years or more, the risk rises to nearly threefold.
The risk is not limited to RA, however. One of the earliest findings of a link between heart disease and osteoarthritis (OA) came in 2003 when a study found that men with OA in just one finger joint were 42 percent more likely to die of heart disease versus men without OA.
The reason for the increased risk of heart disease in arthritis patients, as is the case with some other arthritis co-conditions, is inflammation. Inflammation, regardless of its source, is a known risk factor for heart disease. RA-related inflammation narrows blood vessels and leads to plaque formation inside of the arteries. If this plaque clogs blood vessels, heart attack or stroke may result. Inflammation can also reshape the blood vessel walls, making the plaque inside the vessels more prone to rupture, which can also trigger a heart attack. As for osteoarthritis, though the disease itself isn’t inflammatory, the damage it causes to joints can lead to inflammation.
The inflammation of arthritis does not act alone, however. There are other independent risk factors for heart disease that can be modified or controlled, such as smoking, high cholesterol, high blood pressure, inactivity, obesity and diabetes. Unfortunately, these risk factors tend to go hand in hand with arthritis: The CDC says that 52 percent of people with diabetes have arthritis, 53 percent with arthritis have high blood pressure, 66 percent with arthritis are overweight, and about one in five people with arthritis are smokers.
While we know that high cholesterol levels are associated with a higher risk of heart disease in everyone, cholesterol levels are more likely to be unstable in people with higher levels of inflammation and RA disease activity. This can lead to an even higher risk of heart attack for people with RA. In addition, some of the medications used for arthritis, such as prednisone, tocilizumab and NSAIDs, appear to increase heart disease risk, while other arthritis drugs offer heart protective benefits (including TNF inhibitors, methotrexate and hydroxychloroquine).
It can be challenging for doctors to assess heart disease risk in people with RA. For example, if someone has high levels of inflammation, cholesterol levels can drop as a result and the low cholesterol levels may lead the doctor to think the person isn’t at high risk for heart problems. However, experts say it’s crucial to get control of RA as early as possible after diagnosis, and to assess risk factors for heart disease when the patient is diagnosed with RA to prevent further cardiovascular damage. Exercise, eating a balanced diet and keeping inflammation in control throughout your body can lower your risk of developing heart disease.