Reumatoid arthritis doubles the risk of heart disease, but the prevalence appears to be declining, thanks to efforts to prevent heart problems and provide early diagnosis and treatment. This is according to research presented at the American College of Rheumatology's annual meeting in San Francisco, CA.
Inflammation is known to contribute to blood vessel damage and is one of the risk factors for heart disease.
Patients with rheumatoid arthritis (RA) have higher levels of inflammation overall, affecting not only joints but also other organs and tissues.
RA-related inflammation causes the narrowing of blood vessels and formation of plaque, a hard substance made out of trapped cholesterol, calcium and other matter, which can block arteries and reduce blood flow.
When pieces of plaque break off and enter the bloodstream, they may clog smaller vessels, causing a heart attack or stroke.
Inflammation can also occur in the wall in the hearts of people with RA, potentially aggravating the risk of heart failure. Signs of heart failure, which include swelling of the lower legs, shortness of breath and fatigue, are common symptoms of RA, and may therefore be overlooked as warning signs.
RA can also lead to inflammation of the pericardium, the two-layered sac that surrounds the heart. The inflamed sacs rub against each other, causing sharp, intense chest pain.
People with RA have, moreover, a greater risk of atrial fibrillation, a heart rhythm disorder associated with heart failure, stroke and death.
Inflammation control is therefore vital in patients with RA to protect the heart as well as the joints.
Heart problems may appear within a year
Previous studies have shown that people with RA have up to twice the risk of cardiac problems, which may occur within a year of diagnosis.
Within 1-4 years of diagnosis, the risk of heart attack rises by 60% and by 50% for other forms of coronary heart disease, such as angina and coronary death.
While the contributing factors are not fully understood, RA and all its risk factors for heart disease clearly need to be addressed as early as possible, to prevent avoidable damage.
Efforts to reduce risk are paying off
The current study shows that recent efforts are having a positive impact on the risk of cardiovascular disease among people with RA.
Researchers led by Dr. Elena Myasoedova, PhD, a rheumatologist at Mayo Clinic in Rochester, MN, looked at deaths from heart disease within 10 years of rheumatoid arthritis diagnosis among two groups of people.
One group was of 315 patients diagnosed with RA from 2000-07; the other was a group of 498 patients diagnosed with RA in the 1980s and 1990s. A control group consisted of 813 people without RA who died of heart disease. Approximately 2 in 3 patients studied were women, with an average age of 60.
The rate of death from heart disease in patients diagnosed in the 1980s and 1990s stood at 7.9%, compared with 2.8% in those diagnosed in 2000-07.
Deaths specifically from coronary artery disease also declined. Among the 2000-07 diagnosis group, 1.2% died of the condition, similar to rates found in the general population; for those diagnosed in the 1990s, the rate was 4.7%.
Dr. Myasoedova says:
"More research is needed to confirm why heart disease deaths among rheumatoid arthritis patients have declined, but potential factors include earlier and more vigilant screening for heart problems, improved treatment for heart disease and rheumatoid arthritis, and in general, more attention to heart health in patients with rheumatoid arthritis."
Medical News Today recently reported that yoga may help relieve the symptoms of rheumatoid arthritis.
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