People with RA face a 50 percent higher risk for
cardiovascular disease. They are significantly more likely to have a heart
attack and more likely to be hospitalized for heart failure. Learn more.
You’re probably all too aware of how arthritis affects your
joints. But having arthritis – osteoarthritis (OA), but especially inflammatory
conditions like rheumatoid arthritis (RA), gout, lupus and psoriatic arthritis
– also puts you at increased risk for heart disease. That includes heart
attack, stroke, atrial fibrillation (irregular heartbeat), high blood pressure,
heart failure, and atherosclerosis (plaque in the arteries).
Those with gout are also at greater risk for a heart attack
or of dying from cardiovascular and coronary heart disease. Gout was linked to
a 15 percent higher risk for heart attack, stroke, or death from heart disease
in a 2018 study published in the Journal of the American Heart Association.
People with OA face a 24 percent higher risk for
cardiovascular disease, according to a meta-analysis of 15 studies that
included nearly 360,000 people. The authors say shared heart disease risk factors
such as high cholesterol and diabetes, along with inactivity and the use of
nonsteroidal anti-inflammatory drugs (NSAIDs), may be behind the increased
risk. Another important contributor to heart disease is inflammation that can
come with OA.
Chronic Inflammation and Your Heart
“Inflammation, regardless of where it comes from, is a risk
factor for heart disease,” says rheumatologist Jon T. Giles, MD, assistant
professor of medicine at Columbia University School of Medicine. “So it’s not
surprising that people with inflammatory arthritis like RA, lupus, and
psoriatic arthritis have more cardiac events.”
Inflammatory cells get into blood vessel walls where they make cytokines – immune system proteins that promote inflammation. Inflammation also reshapes blood-vessel walls, making deposited plaques more prone to rupture. A rupture, in turn, can trigger a heart attack.
The risk isn’t limited to people with inflammatory arthritis. Although OA is not in itself inflammatory, its damage can cause inflammation, which in turn increases the risk of heart disease.
Work with your rheumatologist to get arthritis under control and ensure you have the lowest amount of systemic inflammation possible. A large study in the 2017 Annals of the Rheumatic Diseases found that people with RA who had their disease well-controlled were less likely to develop cardiovascular disease.
One of the best ways to manage your disease is with medication. Some, but not all, arthritis drugs will help you avoid heart problems.
Inflammatory cells get into blood vessel walls where they make cytokines – immune system proteins that promote inflammation. Inflammation also reshapes blood-vessel walls, making deposited plaques more prone to rupture. A rupture, in turn, can trigger a heart attack.
The risk isn’t limited to people with inflammatory arthritis. Although OA is not in itself inflammatory, its damage can cause inflammation, which in turn increases the risk of heart disease.
Work with your rheumatologist to get arthritis under control and ensure you have the lowest amount of systemic inflammation possible. A large study in the 2017 Annals of the Rheumatic Diseases found that people with RA who had their disease well-controlled were less likely to develop cardiovascular disease.
One of the best ways to manage your disease is with medication. Some, but not all, arthritis drugs will help you avoid heart problems.
Arthritis Drugs and Your Heart
A few of the drugs you take to manage joint pain can also
protect your heart. Most disease-modifying anti-rheumatic drugs (DMARDs) –
including methotrexate, sulfasalazine (Azulfidine), and hydroxychloroquine
(Plaquenil) – appear to have a protective effect. Tumor necrosis factor
inhibitors (TNF inhibitors) such as adalimumab (Humira), etanercept (Enbrel),
and infliximab (Remicade), also protect the heart by reducing inflammation in
the body.
On the flip side, other arthritis drugs actually harm the heart. NSAIDs have become notorious for increasing the risk for heart attack or stroke. In 2018, the FDA issued a stern warning about these drugs, cautioning that they can lead to heart events within just a few weeks of use. The risk increases the longer you take them and the higher dose you use. If you do take an NSAID, use the smallest possible amount for the shortest period of time needed to manage your symptoms.
Also risky is the steroid drug, prednisone. Though it works by lowering inflammation, prednisone can also raise blood pressure, increase cholesterol levels, and harden the arteries. If you have to take steroids, balance your desire for arthritis relief with the need to protect your heart.
On the flip side, other arthritis drugs actually harm the heart. NSAIDs have become notorious for increasing the risk for heart attack or stroke. In 2018, the FDA issued a stern warning about these drugs, cautioning that they can lead to heart events within just a few weeks of use. The risk increases the longer you take them and the higher dose you use. If you do take an NSAID, use the smallest possible amount for the shortest period of time needed to manage your symptoms.
Also risky is the steroid drug, prednisone. Though it works by lowering inflammation, prednisone can also raise blood pressure, increase cholesterol levels, and harden the arteries. If you have to take steroids, balance your desire for arthritis relief with the need to protect your heart.
Lifestyle Factors and Your Heart
Having arthritis alone doesn’t destine you to develop heart
disease. Lifestyle factors like obesity, high blood pressure, diabetes and high
cholesterol also play into your chances. These factors often overlap in people
with arthritis. According to the Centers for Disease Control and Prevention
(CDC), 47 percent of people with diabetes have arthritis, as well as 31 percent
of those who are obese. And nearly half of all adults with heart disease also
have arthritis.
Smoking is a heart disease risk factor, too. It raises blood pressure, lowers HDL (“good” cholesterol), and speeds plaque buildup in arteries. No matter how long you’ve smoked, it’s never too late to quit. Medications, nicotine-replacement products, and counseling can all help speed your transition off cigarettes.
Diet and exercise can help you lose weight, lower blood pressure and cholesterol, and manage diabetes. Yet exercising can be especially difficult for those with OA who are overweight or obese. It’s a vicious cycle: You’re in pain, so you don’t exercise. Not exercising means your joints hurt even more. To overcome these obstacles, find a fitness program that suits your abilities, get your doctor’s advice, and start slowly.
Smoking is a heart disease risk factor, too. It raises blood pressure, lowers HDL (“good” cholesterol), and speeds plaque buildup in arteries. No matter how long you’ve smoked, it’s never too late to quit. Medications, nicotine-replacement products, and counseling can all help speed your transition off cigarettes.
Diet and exercise can help you lose weight, lower blood pressure and cholesterol, and manage diabetes. Yet exercising can be especially difficult for those with OA who are overweight or obese. It’s a vicious cycle: You’re in pain, so you don’t exercise. Not exercising means your joints hurt even more. To overcome these obstacles, find a fitness program that suits your abilities, get your doctor’s advice, and start slowly.
Quick Facts
·
People with RA have a 50-70 percent
higher risk for cardiovascular disease than the general population.
·
People with OA face a 24 percent
higher risk for cardiovascular disease than the general population.
·
Nearly half of all adults with heart
disease also have arthritis.
Sources
Chodara AM, et al. Managing cardiovascular
disease risk in rheumatoid arthritis: clinical updates and three strategic
approaches. Current Rheumatology Reports. 2017;
19(4):16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5789778/
Schieir O, et al. Incident
myocardial infarction associated with major types of arthritis in the general
population: a systematic review and meta-analysis. Annals of the Rheumatic
Diseases. 2017; 76(8):1396-1404. https://www.ncbi.nlm.nih.gov/pubmed/28219882
Khalid U, et al. Incident heart
failure in patients with rheumatoid arthritis: A nationwide cohort study. Journal
of the American Heart
Association. 2018;7:e007227. https://www.ahajournals.org/doi/10.1161/JAHA.117.007227
Pagidipati NJ, et al.
Association of gout with long-term cardiovascular outcomes among patients with
obstructive coronary artery disease. Journal of the American Heart
Association. 2018;7:e009328. https://www.ahajournals.org/doi/10.1161/JAHA.118.009328
Wang H, et al. Osteoarthritis and the
risk of cardiovascular disease: a meta-analysis of observational studies. Scientific
Reports. 2016;
6:39672. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5177921/
Arts EE et al. Low disease activity
(DAS28<3.2) reduces the risk of first cardiovascular event in rheumatoid
arthritis: a time-dependent Cox regression analysis in a large cohort
study. Annals of the Rheumatic Diseases. 2017;
76(10):1693-1699. https://www.ncbi.nlm.nih.gov/pubmed/28606965
Roubille C, et al. The effects
of tumor necrosis factor inhibitors, methotrexate, non-steroidal
anti-inflammatory drugs and corticosteroids on cardiovascular events in
rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review
and meta-analysis. Annals of the Rheumatic Diseases. https://ard.bmj.com/content/74/3/480.
Mangoni A, et al. Methotrexate
and cardiovascular protection: Current evidence and future
directions. Clinical Medicine Insights: Therapeutics. 2017. https://journals.sagepub.com/doi/full/10.1177/1179559X17741289
Ljung L, et al. Response to
biological treatment and subsequent risk of coronary events in rheumatoid
arthritis. Annals of the Rheumatic Diseases. 2015. https://ard.bmj.com/content/75/12/2087.
U.S. Food & Drug Administration.
FDA Drug Safety Communication: FDA strengthens warning that non-aspirin
nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or
strokes. https://www.fda.gov/Drugs/DrugSafety/ucm451800.htm
Crawson CS, et al. Rheumatoid
arthritis and cardiovascular disease. American Heart Journal.
2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3890244/
CDC:
Comorbidities. https://www.cdc.gov/arthritis/data_statistics/comorbidities.htm
Much of the early treatment of heart failure relates to the treatment of the symptoms of heart failure such as diuretics, once acute symptoms are under control, then longer-term strategies are considered.
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