Rheumatoid arthritis (RA) is not just a painful autoimmune disease that can greatly impact an individual’s quality of life. This disease also comes with some increased risk factors that people should be aware of. RA is associated with increased risk of death that is related to an increased risk of cardiovascular disease.
This is not a new finding. For many years the link between RA and cardiovascular morbidity has been established. Years of research has shown that people with RA have twice the risk of having a heart attack as someone without RA. This is similar to the increased cardiovascular risk that people with diabetes have. Heart attacks are not the only potential cardiovascular complication however. RA patients are also at greater risk for developing valvular heart disease, arrhythmia, pericarditis, and endocarditis. These patients also have double the risk of heart failure with poorer outcomes in comparison to non- RA patients.
For RA patients with more traditional cardiovascular risk factors such as obesity, smoking, high cholesterol, and high blood pressure, this cardiovascular risk is of course even higher. Yet, these risk factors are clearly not what makes RA patients at more risk overall. Some research has shown that medications that RA patients take may predispose them to atherosclerosis, but that the suspected main culprit is the constant inflammatory state that the bodies of RA patients are in. Additionally, due to the pain and difficulty moving, RA patients often lead a pretty sedentary lifestyle. As most of us know, activity and exercise are important for maintaining a healthy heart.
New research about negative outcomes
Research continues to prove that RA patients are at greater risk for poor cardiovascular outcomes. Recently, a study was published in The Journal of Rheumatology that showed how patients with RA who tested positive for rheumatoid factor (RF) antibodies had a significantly increased 10-year risk for cardiovascular morbidity. Patients who tested positive for anticyclic citrullinated peptide antibodies (anti-CCP) did not seem to have the same increased risk.
The research team hails from the Radbound University Medical Centre in Nijmegen, in the Netherlands. They used data from an early cohort of RA patients that was gathered for an ongoing long-term observational study in1985. These cohort patients received standard follow-up until they either dropped out of the study or died.
In order to be eligible for this study, patients needed to test positive for anti-CCP or RF and have no history of cardiovascular decline at the start and at the 6-month follow-up. Once these factors were accounted for, a total of 929 patients were included; 628 anti-CCP positive patients, and 697 RF-positive patients. Among the 929 patients, there were 162 cardiovascular events during follow-up. These events included 101 cases of ischemic heart disease, 45 cases of nonhemorrhagic cerebrovascular accidents, and 16 cases of peripheral artery disease. On average 7.5 years passed between the date of diagnosis and the date of the cardiovascular event. Among the two groups of patients, 112 of the cardiovascular events took place in the anti-CCP-positive group, and 50 took place in the anti-CCP-negative group.
After the statistical analysis was conducted, it showed that there is no effect of anti-CCP status on the cardiovascular outcomes of a patient with RA. Cardiovascular disease risk was shown to be highest in RF-positive patients and anti-CCP-negative patients. Previous studies on these factors had revealed mixed results, so more research is likely needed to develop a firm conclusion. In science the results of one study are usually not enough to say whether something results in an increased risk of something else developing.
It often takes years of research and comparing multiple studies before conclusions can be drawn. Yet, it is clear that RA patients still remain at greater risk for cardiovascular disease. So how can they stay healthy?
So, what should RA patients do?
Ultimately, what research is showing is that there is a combination of factors that make people with RA at greater risk for developing cardiovascular disease. This means that it can be difficult to know what to focus on when trying to lessen this risk, but a good place to start is to look at the risk factors that are modifiable. Maintaining good cardiovascular health is something that everyone can work on. While some of the things may be a bit more challenging for people with RA, it is not impossible.
Interestingly, the possibility of a patient with RA being a smoker or an ex-smoker is about 1.5 times higher than the general population. However, a link between smoking and RA development has already been established so maybe this is not as surprising as it seems. Additionally, smoking has been associated with the presence of rheumatoid factor (RF) and anticitrullinated protein antibody (ACPA). With the link between smoking and RA, and smoking and cardiovascular disease being well established, it is imperative that providers talk with patients about why stopping smoking is so important for their health. While it may seem impossible to quit, with the right support and resources it is not. This can have a huge impact on someone’s cardiovascular health.
High blood pressure, or hypertension is becoming more and more common. It is well known that hypertension is associated with cardiovascular decline. Currently there have been mixed results regarding the association between people with RA and the incidence of hypertension. However, when present, this signifies yet another opportunity for people to take control of their health. Things such as diet, exercise, stress, and alcohol intake can play a huge role in hypertension development. People with RA and hypertension should talk with their healthcare providers openly about their lifestyle habits. If they have a diet that is high in salt and fat, these are things that they can try to modify. Additionally, if they are under a lot of stress they should look at ways to reduce this. Sometimes talking with a professional about the things in life that are stressing you out, can help you develop tools for coping with these situations. This could not only positively affect your hypertension, but could also improve your quality of life in general.
Obesity and high cholesterol or dyslipidemia are other factors that can patients can modify to help decrease their risk for cardiovascular morbidity. Often, managing these conditions involves a lot of changes to diet and exercise. For people with RA having a healthy diet that involves lots of fruits and vegetables can also help with immune support. It can be a little complex to maintain a diet that works for you, especially if you are also trying to avoid foods that can contribute to inflammation. Talk to your provider about setting you up with a Registered Dietician who can work with you to find an eating plan that meets your individual needs. Exercise can also be difficult for people with RA, but staying sedentary is not the answer. Exercise is extremely important for cardiovascular health, but that does not mean that you have to become a marathon runner. There are many activities that will help you get the exercise that you need without putting undo stress on your joints. Look into swimming, biking, or yoga. Not only are these fun and easier on your body, but they can be a great way to meet new people, too!