RA and Your Heart
Clinical evidence shows a direct link between rheumatoid arthritis and heart disease.
Inflammation is known to contribute to blood vessel damage and is also one of the risk factors for heart disease. Generally, patients with rheumatoid arthritis (RA) have higher levels of inflammation in their bodies, which can affect other organs and tissues besides the joints. In fact, people with RA have up to twice the risk of heart disease and development of heart failure (especially if they test positive for rheumatoid factor, or RF) than the general population, according to 2013 Mayo Clinic study published in the American Heart Journal.
How Does Rheumatoid Arthritis Affect Your Heart?
RA-related inflammation causes blood vessels to narrow, which results in the formation of plaque, a hard substance made out of trapped cholesterol, calcium and other matter, which can block arteries and make it hard for blood to flow. Pieces of plaque can break off and go into the bloodstream, where they may clog a smaller vessel and cause a heart attack or stroke.
The wall in the heart of people with RA can also become inflamed, possibly contributing to the higher risk of heart failure. Often, the usual warning signs of heart failure are overlooked: swelling of the lower legs may be mistaken for ankle inflammation, shortness of breath may go unnoticed because people with RA tend to exercise less than others, and fatigue is also common in people who have RA.
Inflammation of the two-layered sac that surrounds the heart known as the pericardium is also more common in patients with RA. The inflamed sacs rub against each other, causing sharp, intense chest pain. In addition, people with RA have a higher risk of developing a heart rhythm disorder called atrial fibrillation, which is associated with higher risk of heart failure, stroke and death. Thus inflammation control is important in patients with RA not only to protect the joints, but also the heart.
Risk of Heart Attack Rises Soon After RA Diagnosis
Patients diagnosed with rheumatoid arthritis may have cardiac problems within one year, according to a 2010 study published in the Journal of Internal Medicine. Among people with RA, the risk of having a heart attack rises by 60 percent in one to four years after the RA diagnosis. The risk of other forms of coronary heart disease such as angina and coronary death rises 50 percent in the same time frame. While not all of the contributing factors are well understood, it is clear that getting RA under control early and addressing all known risk factors for heart disease at the time of diagnosis is vital in preventing further cardiovascular damage.
Determining Your Risk for Heart Disease
When diagnosed with RA, your doctor will check for such heart disease risk factors as high blood pressure, high cholesterol, high body mass index, and your family history of heart disease. He or she can also note the amount of visceral fat (or belly fat), which is more highly associated with cardiovascular disease than fat located elsewhere.
Generally, the more severe your RA, the more likely you are to develop cardiovascular problems, such as heart attack, stroke and heart failure. Certain medicines used to manage RA can also contribute to heart disease, such as NSAIDs and corticosteroids, and should be used with caution if you have other risk factors for heart disease.
In addition, women with RA who go through menopause before age 45 have an increased risk of heart disease. This is because the body’s production of the hormone estrogen is lower after menopause, and estrogen is protective against heart disease.
Nonetheless, assessing risk for heart disease in someone with RA can be challenging. For example, high inflammation sometimes causes cholesterol levels to drop, so a doctor may not think a person with RA is at risk for heart disease if the tests show low cholesterol. The same is true about weight—high inflammation is associated with weight loss, so again, a physician may think a thin person with RA has low cardiac risk.
Researchers are working to identify more specific immune system markers, such as a rise in the levels of certain cytokines (pro-inflammatory molecules produced by the immune system), which is associated with the development of heart disease in RA patients.
What You Can Do to Protect Your Heart?
An active lifestyle, balanced nutrition and good control of your body-wide inflammation can lower your risk of developing cardiovascular problems. Talk with your doctor about what may be best for you. Ask about programs available in your area to help you stay physically active. You may also consider a consultation with a nutrition expert.
Updated April 2015
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