If you have rheumatoid arthritis (RA), you already know its effect on your joints.  But did you know that the same inflammation that damages your joints can also harm your cardiovascular (heart and blood vessel) health? Mounting evidence continues to warn of this link. Here’s what you need to know.

How does RA affect my heart?

RA-related inflammation can cause your blood vessels to narrow, trapping fat, cholesterol, calcium and other things that form plaque – a hard substance that clogs arteries and makes it hard for blood to flow through the body. The plaque also tends to be less stable and more prone to rupture.  “What we worry about is that the plaque will dislodge from a blood vessel and go into the bloodstream, plugging a smaller vessel and causing a heart attack,” says rheumatologist Sherine Gabriel, MD, MSc, professor of medicine and epidemiology at Mayo Clinic in Rochester, Minnesota.

In fact, according to a 2013 Mayo Clinic study published in the American Heart Journal, people with RA have 1.5 to 2.0 times the risk of heart disease than the general population.  The same study also found that patients with RA have twice the risk of developing heart failure, especially if they test positive for rheumatoid factor (RF factor). 

Inflammation in the wall of the heart is more frequent than previously thought,” says rheumatologist Jon T. Giles, MD, MPH, assistant professor of medicine, division of rheumatology at Columbia University Medical Center in New York. While researchers don’t yet understand the consequences of those changes, Dr. Giles says “it’s possible they could lead to heart failure.”

Most heart failure involves a problem with the pumping cycle, not the relaxation cycle.  “But people with RA have the less common kind of heart failure involving the relaxation phase,” says Gabriel. Patients with RA tend not to have classic symptoms of heart failure, which means warning signs may be overlooked.

Common symptoms of heart failure – such as swelling of the lower legs – “may be mistaken for ankle [inflammation]” says Dr. Giles. Shortness of breath, common in patients with heart failure, may go unnoticed because people with RA tend to exercise less than others.

Science behind the RA-heart link

Findings from a series of studies, presented at the American College of Rheumatology 2013 annual meeting, have uncovered details about the specific ways that RA raises your heart disease risk.

  • The more severe your RA, the more likely the risk of heart problems. A study of 526 patients with RA found that the higher the patient’s RA severity score (based on an index called Claims-Based Index of RA Severity, or CIRAS) over more than seven years, the greater their risk of heart-related problems such as heart attack, stroke and heart failure.
  • Immune response to a common virus linked to heart disease.  A study of 324 patients with RA revealed that the body’s immune response to cytomegalovirus, a common virus—measured by a reading of the rise in pro-inflammatory molecules called cytokines—correlated with the development of heart disease.
  • Early menopause raises risk.  A study of 600 women with RA who were followed for several decades found that women who developed menopause before age 45 had an increased risk of heart disease. “Estrogen is protective against heart disease,” says Gabriel. “That may be even more important in women with RA.”   The study found that women with RA with many children—especially 7 or more—also had a higher risk of heart disease than women who had fewer children or who reached menopause after age 45.
  • Heart rhythm disorder can cause sudden cardiac death.  A study of 1300 people, half with RA and half without, found that people with RA have a higher risk of developing prolonged QT interval, which can lead to sudden cardiac death.  The risk is greater if they also have a higher erythrocyte sedimentation rate (ESR or SED rate), a blood test measuring inflammatory activity.