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Understanding heart disease and death in RA
What problem was studied?
Rheumatoid arthritis (RA) is a chronic, systemic disease that not only can cause
debilitating joint destruction but also can result in a shortened lifespan.
Several previous epidemiology studies have shown that there is a higher rate of
cardiovascular (CV) disease and CV-related deaths among people with RA compared
to those without RA. Two independent research teams at Brigham and Women’s
Hospital in Boston and at the Mayo Clinic in Rochester, Minnesota, set out to
learn more about the reasons for this difference.
Arthritis Foundation-funded researchers
involved in the studies: Brigham and Women’s Hospital, Boston Team: Daniel H.
Solomon, MD, MPH, AF Clinical Science Grant & Elizabeth W. Karlson,MD, AF
Arthritis Investigator Award; Mayo Clinic, Rochester, MN Team: Sherine E.
Gabriel, MD, MSc, AF Clinical Science Grant & Paulo J. Nicola, MD, and Hilal
Maradit-Kremers, MD, MSc, supported by AF North Central Chapter Grants
What was done in the study?
The Boston team surveyed participants in the Nurses’ Health Study, a group of
114,000 women followed since 1976. The survey asked about traditional heart
disease risk factors such as smoking, alcohol intake, obesity, high blood
pressure, diabetes, high cholesterol, and family history of heart attacks. Blood
samples from a subset of the women were examined to look for “biomarkers” or
signs associated with a high heart disease risk, including cholesterol levels
and some novel markers of inflammation. The team confirmed who had RA by
checking medical records.
The Mayo Clinic team used a county-wide medical record system to identify all of
the residents of Rochester, Minnesota who were diagnosed with RA over a 40-year period. From the same set of records, they
selected another study group of people without RA who matched the age and sex of
each of the RA patients. They examined the medical records of both groups to
compare the incidence of heart disease and traditional risk factors. They also
looked at indicators of systemic inflammation and RA disease severity.
What were the study results?
The Boston group identified 287 women with RA. Compared to the 87,000 surveyed
women without RA, those with RA were significantly more likely to report that
they did not drink alcohol and did not smoke in the past. There were no
significant differences in current smoker status, any of the other traditional
risk factors or in the blood cholesterol levels. However, the levels of several
inflammatory biomarkers linked to heart disease were significantly elevated in
the women with RA.
In a series of recent articles, the Mayo group reported that in comparison to
the non-RA group, the 575 patients with RA had a significantly higher risk of
heart disease, were less likely to report symptoms of angina and more likely to
experience unrecognized symptoms of a heart attack and sudden cardiac death. The
odds of developing congestive heart failure or a weakening of the heart’s
ability to pump blood was double in the RA patients. As in the Boston study,
traditional risk factors did not explain the increased risk of heart disease,
heart failure or death. In fact, a high body mass index (a measure of
obesity) is a known risk factor in the general population. But RA patients with
a low body mass index, (which can be a possible consequence of
inflammation), had a significantly higher risk of death from heart disease. The
Mayo team also found that markers of systemic inflammation were associated with
a significantly increased risk for CV death.
What’s the relevance to people with arthritis?
These studies provide further evidence that the widespread inflammation in RA is
linked to heart disease and an increased risk of early death. The findings
highlight the need to pay attention to heart disease and its prevention in
people with RA. “Further research in this area is crucial as it is perhaps the
only place where we can make an impact on the life expectancy of people with
RA,” Dr. Sherine Gabriel says. “We are now very close to being able to identify
those people with early RA at particularly high risk of heart disease so that we
can intervene early and prevent excess CV-related disease and mortality.”
Sources: Arthritis and Rheumatism,
November 2004, February 2005 and March 2005
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15529391
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15529378
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15692992
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15751097
  
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