• Cardiovascular

    Many Factors Play into Increased Heart Disease Risk for Those with RA

hands in the shape of a heart, with a red heart health awareness ribbon in the middle

In honor of Rheumatoid Arthritis Awareness Day and National Heart Health Day we are posting a previous Mayo Clinic Q & A article that addresses this issue.

DEAR MAYO CLINIC: Is it true that people with rheumatoid arthritis have a higher risk of heart disease? How are the two conditions related? Is there a way to lower the risk?

ANSWER: Studies have shown that if you have rheumatoid arthritis, your risk of developing heart disease is two to three times higher than people who do not have the disorder. Although the exact connection between the two conditions is unclear, a number of factors seem to play into the increased heart disease risk. Regular check-ups, tests to check for heart problems, lifestyle changes and being able to recognize symptoms of heart disease can all help manage the risk.

Rheumatoid arthritis is an inflammatory disease that causes swelling. It often affects the small joints in the hands and feet and causes joint tenderness, pain and stiffness. But the disorder can go beyond the joints, too, and that is part of the connection to heart disease.

The inflammation of rheumatoid arthritis may cause changes within the walls of your arteries. That can make the arteries narrow, lowering blood flow and raising blood pressure. Also, plaque can build up in the arteries — a condition called atherosclerosis.

Atherosclerosis is related to the typical risk factors for heart disease: high blood pressure, high cholesterol, diabetes and smoking. But in people with rheumatoid arthritis, inflammation may also trigger plaque formation. Rheumatoid arthritis can affect the heart muscle, too, making it stiff and reducing its ability to effectively pump blood. That makes the heart more prone to heart failure.

Drugs used to treat rheumatoid arthritis can raise your risk of heart disease. For example, steroid medications are very effective at decreasing inflammation. However, in high doses over a long period of time, these medications can raise blood pressure, contribute to weight gain and raise cholesterol levels. All of these side effects can increase the likelihood of heart problems. Nonsteroidal anti-inflammatory drugs often used to ease joint pain have been shown to have negative effects on blood pressure and overall heart disease, as well.

Because people with rheumatoid arthritis are at high risk for heart problems, ongoing monitoring is key. Imaging exams and blood tests can help identify stiffness in the heart muscle and arteries, as well as early signs of artery blockages. If tests reveal these or other signs of heart disease, your health care provider can be proactive about treating them promptly.

It is also important to keep an eye on traditional heart disease risk factors, such as blood pressure and cholesterol levels. If they rise, then you may need treatment to help keep them under control, making it less likely that they will lead to heart problems.

Managing the inflammation of rheumatoid arthritis carefully can make a difference, too. For example, if steroids are part of your treatment plan, they should be used for the shortest amount of time possible, at the lowest dose possible.

Make sure you understand the symptoms that may signal heart problems. In some people who have rheumatoid arthritis, symptoms of heart disease may not show up in the same way as they do in other people. Ask your doctor about symptoms to watch for.

Finally, work to maintain overall heart health. Follow a heart-healthy diet, get to and stay at a healthy weight, reduce stress, get enough sleep and exercise regularly. Exercise can be challenging if your joints hurt from rheumatoid arthritis. If so, consider working with a physical therapist or an exercise physiologist to find the best exercise for you.

If you have rheumatoid arthritis, ask your doctor about your risk for heart disease. Taking that risk into consideration, set up an ongoing care plan to monitor both your arthritis symptoms and your heart health. If possible, include a cardiologist and a rheumatologist on your care team. Together, they can help you lower your heart disease risk while managing rheumatoid arthritis. — Rekha Mankad, M.D., Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.

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