If you have rheumatoid arthritis (RA), you already know its effect on your joints.  But you may not realize that the same inflammation that affects your joints may also be affecting your heart.

A study done at the Arthritis Research Centre of Canada in Vancouver and published in the June 2012 issue of Arthritis Care & Research highlights the danger:  It found that patients who stopped taking statins – prescribed for high cholesterol – had a 60 percent increased risk of death from heart disease and a 79 percent increased risk of death from all causes compared to people with RA who continued taking their statins. 

Statins not only lower artery-clogging cholesterol but may also lower inflammation, says Jon T. Giles, MD, MPH, assistant professor of medicine, Division of Rheumatology at Columbia University in New York.

Yet another study at Johns Hopkins University published in a 2012 issue of Seminars in Arthritis and Rheumatism found that 80 percent of RA patients and 81 percent of control subjects had at least one modifiable traditional cardiovascular risk factor like high blood pressure, diabetes, elevated LDL and body mass index, and smoking. But 57 percent of the RA patients had high blood pressure compared to only 42 percent of the controls.

“We think that the difference is a reflection of inflammation,” says Cecilia P. Chung, MD, study author and now a fellow in rheumatology at Vanderbilt University in Nashville. 

Inflammation may reduce nitric oxide and activate an enzyme called angiotensin converting enzyme (ACE), both of which constrict blood vessels.  Blood vessel constriction, in turn, raises blood pressure. “It also causes more oxidative stress,” physiological stress that can damage the body, says Dr. Chung.

Pro-inflammatory cytokines – the proteins in the immune system that stir up RA – may also play a role in stoking heart disease, says Dr. Giles. “If you block cytokines in animals, they have less atherosclerosis [a build-up of fat in the arteries] so that may be where the initial parallel is with RA and heart disease,” he says.

“Inflammation may also change the way blood vessels react to cholesterol,” continues Dr. Giles. “The more inflammation, the thinner the plaque [in the coronary arteries] can get. And the thinner it is, the more likely it is to rupture and cause a heart attack.”

In addition to high blood pressure and heart attacks, people with RA are more at risk for heart failure. “The main reason that most people have heart failure is from atherosclerosis that kills off heart muscle over time,” says Dr. Giles. “So, people with RA could have more heart failure because they have more atherosclerosis.”

An Underestimated Risk

Yet cardiovascular risk to those with RA may be routinely underestimated, according to a 2012 study done by the Mayo Clinic and published in a 2012 issue of the American Journal of Cardiology. When researchers compared actual heart events with events that might have been predicted using standard tests like the Framingham Risk Scores that apply to the general population, they found the scores hugely underestimated the risk of heart disease in people with RA.

”We think that something about RA – the chronic inflammation that accelerates atherosclerosis  and increases the risk for heart disease –  is not captured in those traditional risk scores,” says study author Sherine Gabriel, MD, professor of medicine and epidemiology at Mayo Clinic in Rochester, N.Y.  

Such scoring systems look at risk factors like cholesterol, blood pressure and smoking: Those all increase risk of heart disease, says Dr. Gabriel. But in RA, another big, yet unmeasured factor – chronic inflammation – contributes to risk as well.

“In general, patient awareness of cardiovascular risk factors is not as good as that of the general population,” says Dr. Giles. “That may be because people with RA are concentrating on their RA therapies, and other aspects of their care may seem less pressing.”

Safeguarding Your Heart

So, how can you minimize the risk that RA causes your heart?

Treat your RA: “Good control over your RA is the number one thing to do to lower your risk of heart disease,” says Dr. Chung. By lowering inflammation, you also lower risk

Know your risk: “Recognize that you’re at high risk, perhaps in the same way that people with diabetes recognize that it too puts them at heart disease risk,” says Dr. Gabriel.

Pay attention to traditional risk factors: Do as much as you would do even if you didn’t have RA, says Dr. Gabriel: Stop smoking, monitor your cholesterol levels and blood pressure and push your doctors to monitor you as well. “Do everything possible to bring those down to as close to normal as possible,” she says.

Understand your meds: Some medications, such as the high use of steroids like prednisone and non-steroidal anti-inflammatories (NSAIDs) may increase your risk of heart disease. “Corticosteroids and NSAIDs are associated with hypertension [high blood pressure],” says Dr. Chung. The mechanism is complex, she says, but the risk resulting from those medications may be due in part to fluid retention. Steroid use is also associated with atherosclerosis.

However, some RA medications – methotrexate, TNF inhibitors, and hydroxychloroquine – may be protective, says Dr. Giles. “It’s a question whether the protection comes from their effect on inflammation or specific effects of the medications themselves.  It may be a mixture of both.”

Live healthy: That means clean up your diet, eating fewer foods high in saturated fat like fried chicken or fries, and eating fewer salty snacks, suggests Dr. Chung.  Salt may be a culprit in raising blood pressure.  Also, if you smoke, quit.  Take up exercise instead, staying as active as you can, says Dr. Gabriel.

“Arthritis can make it difficult to do all kinds of exercise. Work with your physical therapist and doctors to develop an exercise program that works around your arthritis and still keeps you active.”