Did you know that rheumatoid arthritis (RA) can increase your risk of developing cardiovascular disease, also known as CVD or heart disease? Why does RA affect your heart health—and what can you do about it?
Heart risks with RA
People with RA have a 50% increased risk to develop heart disease compared to people without RA. When you have RA, your risk of heart failure is doubled too.
RA also increases your risk of developing high blood pressure or atrial fibrillation, also known as AFib, an abnormal heart rhythm. Having RA makes you more likely to have a stroke or heart attack at some point in your life. At time of diagnosis with RA, people are three times more likely than the general population to have had at least one heart attack already.1
Why? High RA inflammation is the main culprit. People with RA who develop heart disease often have elevated levels of inflammatory biomarkers in their blood, including C-reactive protein (CRP), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR) and anti-citrullinated protein antibodies (ACPA), among others. Heart disease is more likely in people with moderate to severe RA.1
RA inflammation changes the way your body processes cholesterol. In fact, you may have low total cholesterol or LDL cholesterol numbers, but high RA inflammation still increases your risk of clogged, hardened arteries.
When your RA disease activity isn’t controlled by your medications, you’re more likely to have low muscle mass and higher fat mass, as well as visceral adiposity, or extra belly fat. This is linked to a greater risk of type-2 diabetes, high blood pressure, metabolic syndrome and inflammation—all of which can lead to heart disease.
But the good news is that you and your doctor can work together to:
- Assess your personal risk of heart disease,
- Track your RA inflammation over time,
- Create a treatment plan to help prevent a heart attack or stroke.
New Vectra Cardiovascular Risk Result: Your healthcare provider can now add Vectra Cardiovascular (CV) Risk to your Vectra Score test results, if you are 40 years of age or older and have not had a prior heart attack or stroke. This result is designed specifically for people with RA, providing a personalized assessment that predicts your risk of having a cardiovascular event like a heart attack or stroke over the next 3 years.
Vectra CV Risk combines RA-specific information and your personal risk factors, including:
- Vectra Score
- 3 additional blood biomarkers
- Your age
- Your clinical history at the time you took the test.
Talk to your doctor about how to add the Vectra CV Risk to your Vectra test so you can check your personalized risk of a heart attack or stroke. Your score will tell you if your risk is low, borderline, intermediate or high over the next 3 years.
If your risk is elevated, you and your doctor can talk about steps to help you lower your risk. Your doctor may consider additional treatments to reduce RA inflammation, or imaging tests like ultrasound to check for signs of atherosclerosis.
Your doctor can also share heart-healthy lifestyle changes you can make now to lower your risk for heart disease—and help your joints feel and function better too.
Why inflammation damages your heart
Inflammation in RA can attack and damage your synovium, the tissue that lines your joints. Inflamed synovial tissue causes pain, swelling and stiffness in affected joints. Over time, this tissue breaks down. It can’t protect cartilage and bone, which leads to joint damage. RA inflammation is systemic and can affect multiple organs in your body and attack other tissues in your body too, including your heart.
Uncontrolled inflammation can cause your arteries to thicken, swell and stiffen up. Over time, you can develop atherosclerosis, or “hardened arteries.” Plaque build-up inside your arteries makes it harder for blood to flow through them. This can lead to a heart attack or stroke.
Here are three important things to watch when it comes to your risk of heart disease:
RA disease activity. If you control your disease activity and keep it low, you actually lower your risk of heart disease. If your disease activity remains high, your heart disease risk goes up. Take your RA medications to lower disease activity and keep it low, and you can protect your heart.
RA treatments. Several drugs used to treat RA, such as methotrexate, sulfasalazine, hydroxychloroquine, and the newer biologics help protect your heart by lowering systemic inflammation. But some arthritis drugs can increase heart disease risk, including NSAIDs and steroids like prednisone. Talk with your rheumatologist about the benefits and risks of taking NSAIDs or steroids for RA flare-ups. If you do need these medicines, your doctor will prescribe the lowest dose for the shortest time necessary to get your flare under control.
Your lifestyle. Obesity, smoking, and a sedentary lifestyle (more time spent sitting than moving) can raise your risk of heart disease along with RA. Some key points:
- If you smoke now, get help to quit! Talk with your doctor about ways to kick the habit if you still smoke. Quitting can lower your risk of a heart attack or stroke. Smoking tobacco also is linked to more severe RA symptoms, and smokers with RA have a harder time reaching remission.
- Get more activity. Aerobic exercises like walking or riding a stationary bike are great for your heart—they’re also called “cardio” for a reason. They exercise your heart as well as your joints and help you burn calories too. Discuss with your doctor what activities may be right for you.
- Eat a heart-healthy diet. Focus on foods rich in fiber, fruits and veggies, olive oil, and lean proteins like fish or chicken. The popular Mediterranean Diet is an easy, flavorful eating style that may help you lower CVD risk and inflammation, and even help you manage your weight.
- Lose weight if you need to. Being overweight or obese is a strong risk factor for heart disease, diabetes and high blood pressure. If you’ve tried to lose weight and haven’t had much success, talk to your healthcare providers. They can suggest online weight loss programs, offer tips to improve your diet or increase physical activity or refer you to a dietitian or online weight loss program.
There’s more good news: The steps you take to improve your heart health and lower your risk of heart disease can also help you improve your RA symptoms:
- Regular exercise is great for joints with RA. Range-of-motion stretches help you maintain flexibility. Resistance exercises build stronger muscles to support your joints. And cardio exercises increase your stamina and overall strength.
- Heart-healthy eating styles like the Mediterranean diet include many “anti-inflammatory” foods and ingredients that may help you ease inflammation and joint pain.
- Losing weight can reduce the pressure on joints like your knees and hips. Less weight and pressure on these joints often mean less pain. If you’re at a healthy weight, you’re more likely to achieve RA remission too, according to research.
Don’t wait to assess your personal risk of heart disease and make healthy changes to lower your risk of a heart attack or stroke. Talk to your doctor about adding the new Vectra CV Risk result to your next Vectra test.
For more resources about RA and heart health, check out A Patient’s Guide to Understanding Rheumatoid Arthritis and Heart Disease on CreakyJoints®.
- Crowson CS, Liao KP, Davis JM 3rd, et al. Rheumatoid arthritis and cardiovascular disease. Am Heart J. 2013;166(4):622-628.e1. doi:10.1016/j.ahj.2013.07.010
- Schieir O, Tosevski C, Glazier RH, et al. “Incident myocardial infarction associated with major types of arthritis in the general population: a systematic review and meta-analysis.” Ann Rheum Dis. 2017 Aug;76(8):1396-1404.
- Tsigalou C, Konstantinidis T, Paraschaki A, et al. “Mediterranean Diet as a Tool to Combat Inflammation and Chronic Diseases: An Overview.” Biomedicines. 2020 Jul;8(7):201.
- Liu Y, Hazlewood GS, Kaplan GG, et al. “Impact of Obesity on Remission and Disease Activity in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis.” Arthritis Care Res (Hoboken). 2017 Feb;69(2):157-165.