Rheumatoid arthritis (RA) is a risk factor for heart disease. This may be due to common risk factors, chronic inflammation, and the effects of RA medications.
RA is a chronic inflammatory condition that affects a person’s joints.
There is evidence that having RA is a risk factor for heart disease. In comparison with the general population, people with RA have around a
RA can cause various problems with the heart, such as coronary artery disease (CAD), which involves the blockage of the arteries. This leads to decreased oxygen and blood supply to the heart. It also has links to heart failure, pericarditis, and myocarditis, the latter two of which involve heart inflammation.
This article explores the connection between RA and heart disease, such as CAD, including their shared risk factors.
It will also look at whether RA medications can cause heart problems before discussing preventive measures, heart disease monitoring, and the symptoms of heart disease.
According to a
One theory that may explain the connection is that chronic inflammation in people with RA damages the circulatory system. Inflammation causes plaque buildup in the arteries, narrowing them and blocking blood flow, which is the main cause of heart attack and stroke.
RA and heart disease also have common risk factors, which could explain why RA is a risk factor for heart disease. These common risk factors include the below.
High blood pressure
People with RA have less elastic arteries. When these narrow, they restrict blood flow, increasing blood pressure. Other factors that may increase blood pressure include exercising too little and taking certain medications.
Around 40% of people with RA have metabolic syndrome, a medical term that encompasses obesity, high triglycerides and cholesterol, high blood sugar, and blood pressure. Metabolic syndrome doubles the risk of heart disease.
Having sore joints makes exercise difficult and weight gain likely. Obesity can contribute to cardiovascular problems, and fat cells release substances that contribute to systemic inflammation.
According to the Arthritis Foundation (AF), there is an association between smoking and aggressive joint destruction. Smoking also contributes to blood vessel damage and artery narrowing. People with RA who smoke are 50% more likely to experience cardiovascular problems than nonsmokers with RA.
RA affects the balance of lipids or fats in the blood. People with RA have:
- high levels of triglycerides
- low levels of low-density lipoproteins (LDL or “bad” cholesterol)
- low levels of high-density lipoproteins (HDL or “good” cholesterol)
Although low LDL has links to better heart health, high triglycerides and low HDL have associations with heart disease.
The medications rofecoxib and valdecoxib are both NSAIDs. However, in 2004 and 2005, respectively, manufacturers had to remove them from the market because they seemed to cause cardiovascular problems.
NSAIDs, both nonselective, such as naproxen and ibuprofen, and selective, such as celecoxib, can increase the risk of CAD.
Other RA medications that can increase the risk of cardiovascular events include glucocorticoids, such as
People may be able to reduce their risk of developing RA and heart disease by:
- quitting smoking, if applicable
- maintaining a nutritious diet
- exercising regularly
- controlling stress
- monitoring blood sugar, blood pressure, and cholesterol levels
- using low doses of NSAIDs and trying alternative pain-relief methods, such as ice, heat, or physical therapy
- using low doses of glucocorticoids sparingly for flare-ups
- maintaining a nutritious diet, such as a plant-based or Mediterranean diet
The AF notes that taking a prescription disease-modifying antirheumatic drug, such as methotrexate, is one of the best ways for someone with RA to protect their heart.
Some people with RA may benefit from regular health monitoring to help detect heart disease early.
- checking cholesterol levels at least every 4–6 years or more often for people with high cholesterol
- checking blood pressure at least every 2 years or more often for those with high blood pressure
Depending on a person’s age, a doctor may also suggest an annual physical and an EKG. If the EKG shows atypical results or a person is experiencing chest pain or other symptoms of CAD, a doctor may also recommend a stress test.
Heart disease may not cause symptoms early on. If people with RA notice the following
- heart palpitations
- shortness of breath
- swollen veins in the legs, ankles, feet, abdomen, or neck
- pain or discomfort in the chest, upper back, or neck
- nausea or vomiting
RA is an inflammatory condition that affects the joints. People with RA have an increased risk of heart disease.
RA and heart disease both involve chronic inflammation, so someone with one condition may be more likely to develop the other.
Shared risk factors for RA and heart disease include high blood pressure, obesity, and smoking. People can lower their risk of both conditions by maintaining a moderate weight, exercising regularly, and avoiding smoking and stress.
Some NSAID medications may impair cardiovascular function, so people can try to reduce their intake and adopt alternative pain-relief methods.