Heart Inflammation Arthritis

It’s well-known that people with rheumatoid arthritis (RA) are at high risk of developing cardiovascular disease, but you might not have realized the extent of the risk. Some research shows that RA patients are up to three times more likely than members of the general population to die from cardiovascular disease. That means RA is as bad as type 2 diabetes as far as your heart is concerned.

While that is serious enough, it turns out that you don’t have to be battling RA for decades for it to affect your heart. A new study, published in the journal the Annals of the Rheumatic Diseases, found that people with new-onset RA already have abnormally stiff arteries compared with healthy patients.

In the study, scientists at the University of Leeds in the UK had 30 people with new-onset RA (diagnosed within the past year) undergo cardiovascular magnetic resonance (CMR) scans. They then repeated these tests at the one- and two-year marks.

An additional 30 participants — healthy volunteers who did not have RA or a history of cardiovascular disease — also had these imaging tests.

The researchers focused in on something called aortic distensibility, which refers to how stiff or elastic the aorta is. (The aorta is the largest artery in the body.) When arteries such as the aorta get too stiff, blood may not flow properly through the body. Aortic distensibility is also considered a surrogate marker that provides a good indication of overall cardiovascular risk.

The CMR scans taken when the study began revealed that the people with newly diagnosed RA had reduced aortic distensibility compared to those in the control group. In other words, their arteries were stiffer, which put them at significantly higher risk of a heart attack, stroke, or other serious cardiovascular event.

The upshot was that getting RA treatment that enabled patients to achieve remission (as defined by DAS28-ESR) made a huge difference in their heart health. In the study, the RA patients were randomly assigned to get either etanercept (Enbrel) plus methotrexate or just methotrexate. (Those in the methotrexate-only group who were not in remission 24 weeks into the study added etanercept to their regimen.)

When the study ended, both RA treatment groups had fared well as far as aortic distensibility was concerned. Their arteries had become more flexible and, thus, their risk of cardiovascular disease decreased. (Those who started with etanercept and methotrexate did not fare any better than those who started with methotrexate and only added etanercept if needed as part of a treat-to-target strategy.)

The impact that RA treatment has on reducing inflammation throughout the body may explain these findings, but only in part, the authors said. They noted that the rheumatic medications may also have “a targeted effect on key immune mediators of [cardiovascular disease].”

“This study demonstrated the presence of [cardiovascular] abnormalities at the earliest stage of RA and the ability of RA therapy to improve vascular stiffness,” they concluded.

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