Rheumatoid Arthritis and Heart Disease

Swollen and painful joints aren’t the only things you need to worry about when you have rheumatoid arthritis (RA). People with RA are almost twice as likely to develop heart disease as those without the condition. Having RA makes you more likely to experience a serious cardiovascular event like a heart attack or stroke.

But just because your joints are inflamed, that doesn't mean you’re destined to have heart troubles. With the right screening and preventive measures, you can keep your heart and blood vessels healthy.

Two factors come together to increase your risk: chronic inflammation and shared risk factors.
Inflammatory substances called cytokines fuel joint destruction in RA and blood vessel damage in cardivascular disease (CVD). Inflammation causes plaque build-up in the arteries, which slowly narrows blood vessels and blocks blood flow, and is the main cause of heart attack and stroke.

The other reason people with rheumatoid arthritis (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 drugs used to treat the disease (such as NSAIDs and steroids). People with RA also have less-elastic arteries that can narrow, which lets less blood through and increases blood pressure.

Metabolic syndrome — Nearly 40% of people with RA have metabolic syndrome, compared to less than 20% of people overall. This collection of symptoms, which includes obesity, high triglycerides and cholesterol, high blood pressure, and elevated blood sugar doubles the risk for CVD. 

Obesity — Sore joints make it hard to exercise, and a lack of physical activity can lead to weight gain. Obesity is linked to CVD risk itself, as well as to cardiovascular risk factors like high blood pressure and high blood sugar. Fat cells release inflammatory substances that contribute to body-wide inflammation and CVD risk.

Smoking — People with RA are more likely to smoke than those without the disease. Not only has this habit been linked to more aggressive joint destruction, but smoking also accelerates blood vessel damage and contributes to artery narrowing. Smokers with RA have a 50%  higher risk for cardiovascular events than do nonsmokers with RA. 

Abnormal lipids — RA has an unusual effect on lipids or fats in the blood. Experts call it the “lipid paradox.” People with RA 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 contribute to cardiovascular disease. 

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 CVD events. Consult the American College of Rheumatology’s latest Guideline for the Rheumatoid Arthritis Treatment.

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 right — 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 risk.  

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 counseling 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 — Though you may rely on NSAIDs and steroids to relieve pain and bring down swelling, these drugs can increase your heart risks. Try to use the smallest dose for the shortest amount of time possible needed to manage your pain. Turn to alternate pain relief methods, such as heat, ice, or physical therapy.

When you have RA, your heart deserves special attention. Ask your rheumatologist and primary care provider what kinds of screening you need.

An evaluation of 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.

Updated 2/11/22