People diagnosed with rheumatoid arthritis (RA) run a greater risk of developing heart disease. But that risk can be spotted and hopefully modified by employing the same criteria used to identify heart disease risk in the general population, a new study suggests.
RA is characterized by inflammation of the lining of the joints and, over time, can lead to joint damage, severe pain, and immobility. Risk factors for heart disease include high blood pressure, high cholesterol, older age, and family history of cardiovascular illness. People diagnosed with rheumatoid arthritis (RA) should be screened using those risk factors as soon as possible following their diagnosis of RA, the study authors said.
Background
"We need to know how can we predict which patients with RA are at a higher risk than others, so that we can then put more effort into the prevention of heart disease in these people," said lead researcher Hilal Maradit Kremers, MD, a research associate with the Mayo Clinic Department of Health Sciences Research in Rochester, Minnesota. "In our study we attempted to do just that, by using a typical cardiovascular risk profile to predict heart disease among these patients."
The study findings follow a 2005 Mayo Clinic report that suggested that the increase in heart disease risk among RA patients may be due to the systemic inflammation brought on by the disease, which in turn, prompts arterial plaque to form blood clots.
According to the Arthritis Foundation, rheumatoid arthritis is a chronic and often disabling disease with no known cause or cure. It affects just over 2 million Americans. Treatments—such as nonsteroidal anti-inflammatories, analgesics and physical therapy-focus primarily on controlling pain and limiting inflammation and joint destruction.
The Study
Dr. Kremers and her colleagues set out to predict the onset of heart disease over the course of a 10-year period among more than 1,100 people, approximately half of whom had just been diagnosed with RA. The patients were 57 years old, on average, and nearly three-quarters were women.
The patients were evaluated on standard indicators for heart disease risk, as detailed by the American Heart Association. The indicators included: gender, having a family history of heart disease, having diabetes; and/or being black. Patients were also examined for other risk factors, such as high cholesterol and high blood pressure. Risky lifestyle habits—including smoking, lack of exercise, and being overweight-were also considered, the researchers said.
Based on the risk assessment scores, the researchers assigned the patients to one of five different risk categories for heart disease-ranging from very low to very high risk. Then the patients were tracked for an average of 12 to 14 years, during which time all incidents of heart attack, heart failure, heart surgeries, and cardiovascular-related deaths were noted.
The Results
The researchers found that while 85% of the RA patients between the ages of 50 and 59 had an intermediate or high risk for developing heart disease within 10 years of diagnosis, just 27% of comparable non-RA patients did. Among patients between the ages of 60 and 69 at the start of the study, 100% of the RA patients had an intermediate or high risk for heart disease, compared with 79% of non-RA patients.
When looking at just "high risk" among the 60 to 69 age group, the difference was even more dramatic-85% for RA patients, compared to just 40% for non-RA patients.
Self-Defense
In light of the findings, the Mayo researchers are encouraging doctors to conduct heart-disease assessment screenings similar to the ones used in the study for each of their RA patients. These screenings should be done as soon as possible following an RA diagnosis and prevention strategies put into place, the researchers said.
"By doing the things that we already know, such as measuring blood pressure, blood sugars, and cholesterol—all the standard things that we look at for the general population—we can help identify the risk for a major cardiovascular event among the RA population," Dr. Kremers said.
Hayes Wilson, MD, chief of rheumatology at Piedmont Hospital in Atlanta, said he endorsed the Mayo researchers' work.
"Anything that helps us characterize and categorize risk factors helps us in the treatment of the disease," he said. "And, until we can figure out what the smoking gun is, hopefully this advice will help us prevent cardiovascular disease or related diseases by helping RA patients better appreciate the risks they face."
