Although not publicly well known, scientists and doctors have known for sometime that rheumatoid arthritis is linked to an increased risk for cardiovascular disease (CVD) including heart attack and stroke. The first person I knew with RA some 20 years ago succumbed to heart problems at the age of 62. When I was informed of his death by his family, they immediately attributed his heart problems to the RA.
My doctors have been tracking some of the variables typically connected with CVD including blood pressure, lipids, and insulin. This came about when a sharp increase in these markers were noted while I was taking Actemra infusions (a listed side effect of Actemra). Even though I’m not on Actemra anymore, we continue to track these variables as the increase may be attributed to active RA.
According to a study at the Mayo Clinic, traditional forms of documenting CVD risk don’t necessarily apply to RA patients, particularly those who are seropositive for rheumatoid factor (RF). Traditional predictors of CVD are helpful with RA patients but not sufficient as in general populations. Systemic inflammation inherent in rheumatoid arthritis may play a role in the increased CVD risk (see this review). Some researchers have called for the development of specific CVD predictors for RA patients as a special population with unique characteristics.
My rheumatologist recently mentioned something called “metabolic syndrome” and it’s relationship to RA. Metabolic syndrome involves a set of interconnected risk factors which are related to cardiovascular disease and diabetes (see this excellent overview from the U.S. National Institutes of Health). All of these complex biochemical processes are connected and involve metabolism of food for energy, sugar processing, insulin, insulin resistance, fat/lipids including cholesterols and triglycerides, liver health, food types, excess weight, exercise, and systemic inflammatory responses. Whenever one of the interconnected systems gets out of normal parameters, a cascade of problems may occur which may impact cardiovascular health. In a study published in 2013, it was found that 18-49% of RA patients also had metabolic syndrome which was significantly higher than general populations. These researchers also found that RA patients with higher inflammatory blood markers and those who used corticosteroids were more likely to show signs of metabolic syndrome. Anti-inflammatory treatments for RA including DMARDS and many of the biologicals like anti-TNFs may impact the biochemical pathways involved in metabolism (see this recent study).
Cardiovascular risk is one extra-articular manifestation of RA that can have serious and fatal consequences. All RA patients and their doctors should be aware of the risk factors, closely monitor CVD related factors, and treat as needed. Ultimately, control of RA and it’s underlying systemic inflammation should help lower CVD risk.