RA and heart disease

Why RA puts you at greater risk for heart disease, and what you can do to protect yourself. 

Swollen and painful joints aren’t the only things you need to think about when you have rheumatoid arthritis (RA). People with RA have a higher risk of developing cardiovascular disease (CVD) such as heart disease or stroke compared to people without RA.  

The good news is you are not destined to have CVD just because you have RA. With the right screening and preventive health measures, you can reduce your risk and keep your heart and blood vessels healthy.

RA and heart disease: What's the connection?

There are two main reasons why people with RA have increased risk of cardiovascular disease: chronic inflammation and shared risk factors.

Inflammatory substances called cytokines that are involved in damaging joints in RA can also damage blood vessels increasing the risk of CVD. Inflammation causes plaque build-up in the arteries, which slowly narrows blood vessels and reduces blood flow, and this increases the risk of having a heart attack or stroke.

The other reason people with RA are more likely to develop heart disease is shared risk factors like these: 

High blood pressure - A number of factors increase blood pressure in people with RA, including a lack of exercise and taking medicines that can increase blood pressure (such as NSAIDs and corticosteroids). Also people with RA tend to have less flexible arteries that can narrow over time, both of which increase blood pressure. 

Metabolic syndrome – Is a group of symptoms, which includes obesity, high triglycerides and cholesterol, high blood pressure, and high blood sugar. Metabolic syndrome is twice as common in people with RA than the general population and having metabolic syndrome doubles the risk for cardiovascular disease.
 
Obesity - Sore joints make it hard to exercise, and a lack of physical activity can lead to weight gain. Also, corticosteroids used to manage RA can cause weight gain and obesity. Obesity is linked to CVD risk itself, as well as to other risk factors such as high blood pressure and high blood sugar. Fat cells also release inflammatory substances that can increase body-wide inflammation and CVD risk.

Smoking - People who develop RA are more likely to have ever smoked than those without RA. Not only is this habit linked to more severe joint destruction, but smoking also accelerates blood vessel damage and contributes to artery narrowing. Smokers with RA have a 50 percent higher risk for cardiovascular events than do nonsmokers with RA. 

Abnormal lipids - RA has an unusual effect on lipids (or fats) in your blood. People with RA tend to have high levels of triglycerides, low levels of low-density lipoproteins (LDL or “bad” cholesterol), and low levels of high-density lipoproteins (HDL or “good” cholesterol). Although low LDL is good for the heart, low HDL cholesterol and high triglycerides is not and can increase the risk of cardiovascular disease. 

You can reduce your risks

One of the best ways to protect your heart is by taking the disease-modifying antirheumatic drug (DMARD) your rheumatologist prescribes—whether that’s methotrexate, a biologic or another medication. There’s evidence that controlling RA inflammation also reduces the risks of heart attack, stroke and other cardiovascular events. 

When it comes to lifestyle interventions, the same advice applies, whether or not you have RA. 

Stay active - Doing aerobic and strengthening exercises on most days of the week can protect your blood vessels, help you lose weight and reduce your CVD risk. There’s also evidence that exercise can fight inflammation.

Eat well - Add extra fruits and vegetables to your diet. Eat more fatty fish like salmon and tuna, which are high in anti-inflammatory omega-3 fatty acids. And avoid saturated and trans fats, which contribute to weight gain and heart disease.  

Control stress - Practice relaxation techniques like deep breathing and meditation to calm you down. 

Quit smoking - Getting off cigarettes can be hard, but it’s not impossible. Ask your doctor to recommend an intervention such as nicotine replacement, medication or counselling to help you quit.

Watch your numbers - Get your blood sugar, blood pressure, and cholesterol levels checked regularly. If they’re high, lower them with diet, exercise, and medications if necessary. 

Find alternate pain-relieving methods - Although NSAIDs and corticosteroids are effective to relieve pain and bring down inflammation, these medicines can increase your heart risks. Talk to your doctor about other treatment options. Try to use the smallest dose for the shortest time possible needed to manage your pain. Also use heat, ice, or physical therapy to help control your joint pain.

Monitor your heart health

When you have RA, you need to also pay attention to your heart health. Ask your rheumatologist and GP what screening tests you need.

Checking your heart health should include regular tests of your blood pressure, blood sugar and cholesterol. The European League Against Rheumatism (EULAR) recommends CVD screening at least once every five years, and every time you change your RA medication. Your doctor may also want to do a stress test, echocardiogram or electrocardiogram to check your heart health.

Be watchful for any symptoms of heart disease, such as shortness of breath, chest pain, or arm pain. Report them to your doctor right away.