You’re probably all too aware of how arthritis affects your joints. But the unfair news is that having arthritis – osteoarthritis (OA), but especially rheumatic 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 RA 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, studies show. High uric acid levels – found in many people with gout – have been linked to a 44 percent increased risk of high blood pressure, according to a 2011 review of 18 studies published in Arthritis Care & Research. “Two studies have made us think that uric acid is causal,” says Boston Medical Center rheumatologist Peter Grayson, MD, lead author of the review.

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 percent more likely to die of cardiovascular disease than those who didn’t have OA. Women were at a 26 percent 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? Here’s a rundown of the reasons.

Chronic inflammation. If there’s an alpha-dog villain that places people with inflammatory arthritis at greater risk of heart disease, it’s 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. “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. Some researchers speculate that there may be a link between the bone damage in OA and blood vessel damage.