You’ve heard it before: “Watch your cholesterol and keep an eye on your blood pressure.” Although everyone should aim for a cholesterol level below 200 and a blood pressure reading in the normal range, it is especially important for those with inflammatory or autoimmune conditions, such as RA and lupus. 

Mounting evidence points to an inflammation-heart disease connection; inflammation contributes to the development of heart disease by making the inner lining of arteries swell, narrowing the opening through which blood can flow. Narrowed arteries increase blood pressure (hypertension) and up the risk of heart attack and stroke. Cholesterol – a component of the sticky fat- and debris-filled substance called plaque – further narrows arteries by clogging them with gunk.

Arthritis Foundation-funded researcher Daniel Solomon, MD, and colleagues at Brigham and Women’s Hospital in Boston, found that women with RA are twice as likely to have heart attacks as those who don’t have the disease. Another inflammation-blood pressure study indicates that a person’s current level of C-reactive protein (CRP) – a key player in inflammation – can indicate future high blood pressure development. In fact, the study’s researchers suggest high blood pressure may be an inflammatory disorder.

If your blood pressure is around 140/90, you might think you’re OK. But recently changed guidelines state that people who have prehypertension – that is, systolic (top number) pressure of 120 to 139 and diastolic (bottom number) pressure of 80 to 89 – are at high risk of developing high blood pressure and should make lifestyle changes, such as quitting smoking, exercising more and losing excess weight.

And what about those cholesterol numbers? Measuring a person’s total cholesterol can be misleading. A more accurate test is one that measures the various components of the total cholesterol level. Cholesterol is carried through the body by lipoproteins, of which there are two basic types: high-density lipoproteins (HDLs) and low-density lipoproteins (LDLs). HDLs are the “good” type; they deposit excess cholesterol in the liver, where it is then metabolized out of the body. LDLs are the “bad” kind; they deposit cholesterol into the arteries.

Experts agree that the LDL level should be kept as low as possible. The standard target has been 100 mg/dL of LDL, but a recent study found significant benefit from driving LDL down into the 60s. HDL should be as high as possible. An HDL level below 40 mg/dL is considered a major risk factor for developing heart disease, so aim for an HDL level higher than 40 mg/dL.