Rheumatoid arthritis and heart disease

 Patients with rheumatoid arthritis (RA) die at a younger age. Do you know what is the commonest cause of death in patients with RA? The incidence of heart attacks is much higher in patients with RA. Just like high cholesterol, diabetes and hypertension - RA is a separate risk factor for heart disease.

It is important for patients with RA to make lifestyle changes to reduce risk of heart attacks.  Measures like quitting smoking, weight reduction, lowering cholesterol and blood pressure could help to reduce the risk.

Current evidence:

RA sufferers are far more likely to die from heart attacks and strokes, a major study has recently revealed. Those with RA are 40% at higher risk of atrial fibrillation and 30% higher risk of strokes than the general public.

The risk of heart attack for RA patients is comparable to those with type 2 diabetes, according to the conclusions of two studies presented at the Annual Congress of the European League Against Rheumatism. 

Patients with untreated or poorly controlled RA are at higher risk of getting heart attacks and early death. Early treatment with disease modifying anti-rheumatic drugs (DMARDs) aiming for complete control of disease activity within the first year of disease is required. Appropriate treatment of RA can protect patients from developing heart problems and such therapy to be commenced early in the disease.

Advise your RA patients to take following ‘self-management’ steps

These changes can reduce your risk of heart disease and give you a greater sense of well-being.

1.      Quit smoking.

2.      Decrease sugar and salt intake.

3.      Avoid processed foods containing trans fats. Use polyunsaturated vegetable-based oils like olive oil when cooking.

4.      Be active often. Research shows that 30 minutes of exercise five days a week can lower blood pressure, cholesterol levels and risk of heart attacks.

5.      Being overweight and obese are major risk factors heart disease. Losing weight can reduce the risk.

Action from doctors:

1.   Annual tests for measuring heart attack risk is mandatory for all RA patients. Regular monitoring of for hypertension, dyslipidemia and diabetes is recommended. 

2.   Lifestyle recommendations (on areas including diet, exercise, smoking cessation and stress management) should be given to all patients with RA.

3.   Early and optimal treatment of RA with DMARDs is essential to reduce inflammatory load.