Arthritis & Heart Disease

Why People With Arthritis Are at Greater Risk for Heart Disease

You’re probably all too aware of how arthritis affects your joints. But the unfair news is that having arthritis – osteoarthritis (OA), but especially inflammatory conditions like rheumatoid arthritis (RA), gout, lupus and psoriatic arthritis – puts you at increased risk of developing heart disease. That includes heart attack, stroke, atrial fibrillation (irregular heartbeats), high blood pressure, heart failure and atherosclerosis (plaque in the arteries).

People with RA tend to be at highest risk. More than 50 percent of premature deaths in people with rheumatoid arthritis result from cardiovascular disease, according to a 2011 review of 24 mortality studies published in Nature Reviews Rheumatology.

People with gout also have a higher risk of heart attack and death from cardiovascular and coronary heart disease. High uric acid levels – a cause gout – have been linked to a 44% increased risk of high blood pressure, according to a 2011 review published in Arthritis Care & Research.

As for people with OA, a study of 8,000 people in Finland, published in the Annals of Rheumatic Diseases, found that men with OA in even a single finger joint were 42% more likely to die of cardiovascular disease than those who didn’t have OA. Women were at a 26% higher risk than those without the disease. The link may be excess weight.

So, why the double whammy of increased heart disease risk when you have arthritis?

Chronic Inflammation 

“Inflammation, regardless of where it comes from, is a risk factor for heart disease,” says rheumatologist Jon T. Giles, MD, assistant professor of medicine at Columbia University School of Medicine in New York City. “So it’s not surprising that people with inflammatory arthritis like RA, lupus and psoriatic arthritis have more cardiac events.”

Inflammation’s cardiac troublemaking works somewhat like this: The inflammatory cells get into blood vessel walls where they make cytokines, immune system proteins that promote more inflammation, says Dr. Giles. “Then the cytokines recruit more inflammatory cells, so they perpetuate the process.”

Inflammation also reshapes blood-vessel walls, making the deposited plaque more prone to rupture. A rupture, in turn, can trigger a heart attack.

The risk isn’t limited to those with inflammatory arthritis. Although OA is not in itself inflammatory, its damage can cause inflammation, which increases the risk of heart disease.

But, as indicated in a 2011 Arthritis & Rheumatism review, inflammation doesn’t act alone. RA patients have to have high levels of inflammation plus other heart disease risk factors, such as high blood pressure or diabetes, before inflammation increases the risk of atherosclerosis.  “The implication is that, in order to reduce cardiovascular risk, you have to reduce not just inflammation, but also the conventional risk factors like high blood pressure, diabetes, high lipids [body fats] and smoking,” says Dr. Giles, the review author.

You do that, he says, by making sure your rheumatologist works with you to get inflammatory arthritis under control so that you have the lowest amount of systemic inflammation possible.

Lifestyle Factors 

According to the American Heart Association, there are six independent risk factors for heart disease that you can modify or control: smoking, high cholesterol, high blood pressure, inactivity, obesity and diabetes.

These also correlate with arthritis. According to the Centers for Disease Control and Prevention (CDC), 52% of people with diabetes have arthritis, 53% with arthritis have high blood pressure, 66% with arthritis are overweight, and about 20% of people with arthritis smoke. Those risks appear to culminate in another formidable figure: According to a National Health Interview Survey, one in four adults with any form of arthritis also has heart disease.

Smoking raises blood pressure and makes it tougher to exercise. It also lowers HDL, or good cholesterol, and speeds up plaque build-up in arteries. “Smoking raises the risk of RA and of heart disease,” says Mayo Clinic researcher Cynthia Crowson. “The best thing you can do is to stop smoking.”

Diet and exercise can help you lose weight, lower blood pressure and cholesterol, and manage diabetes. Getting that exercise can be especially difficult for those with OA who are overweight or obese. It’s a vicious cycle: You’re in pain, so you don’t exercise, and not exercising means your joints hurt more. That can lead to a sedentary lifestyle that increases your heart disease risk.