People with rheumatoid arthritis understandably focus on caring for their joints. But their most serious health risk involves their heart. Compared to the general population, rheumatoid arthritis patients have a significantly increased risk of heart attack and stroke and a shorter life expectancy.

Here are some of the findings from recent studies:

• Heart attacks are twice as common among women with rheumatoid arthritis as among those without the disease.
• Atherosclerosis ("hardening of the arteries") starts early and progresses more rapidly in people with rheumatoid arthritis.
• Carotid artery blockages (a risk factor for stroke) are three times more common in people with rheumatoid arthritis than in people without the disease (44 percent vs. 15 percent).
• Cardiovascular events, such as heart attack and stroke, occur about 10 years earlier in people with rheumatoid arthritis.
• Mortality is higher among rheumatoid arthritis patients after a first heart attack.
• Blood vessel damage is often already apparent at the time of rheumatoid arthritis diagnosis.
• Heart attacks in rheumatoid arthritis patients are more likely to be silent or to occur without the typical symptoms, and they more often result in sudden cardiac death.
• Congestive heart failure (weakening of the heart’s pumping ability) is more common among people with rheumatoid arthritis.

Researchers have identified several links between rheumatoid arthritis and cardiovascular disease. Inflammation is believed to be the most important of these. Cardiologists now understand that inflammation plays a crucial role in the onset of atherosclerosis. They believe that an injury to the inner lining of the arteries (the endothelium) triggers an immune response, sending immune system cells rushing to repair the damage.

But in chronic inflammatory states such as rheumatoid arthritis, the immune response doesn't shut off after the injury heals. The accumulating immune system cells attract deposits of cholesterol, blood platelets, cellular debris, and calcium, which clump together to form plaque. As plaque deposits grow, they restrict blood flow through the artery. If the plaque ruptures, clots can break away and travel to the heart or brain, where they may cause a heart attack or a stroke.

Bottom Line Advice: What Can You Do?
The relationship between rheumatoid arthritis and the heart is complex, and rheumatologists still have a great deal to learn about how to reduce the risk of cardiovascular disease among people who have rheumatoid arthritis. For now, it's important to do everything possible to reduce the traditional risk factors for heart disease and stroke: smoking, obesity, a sedentary lifestyle, high blood pressure, high cholesterol, and diabetes.

Getting regular exercise and losing extra pounds (even a 5-10 percent weight reduction is beneficial) will help your joints as well as your heart. Monitor your blood pressure and have your cholesterol levels checked regularly. Also, ask your physician about the possibility of taking a low-dose aspirin each day to reduce your risk of cardiovascular disease. In addition, the cholesterol-lowering medications known as statins - atorvastatin (Lipitor) and others - not only help the heart, but also have modest beneficial effects on rheumatoid arthritis-related inflammation. If your doctor hasn't already suggested one of these, you might ask about it.

Used with permission. For further information, see Johns Hopkins Medicine 2008 Arthritis White Paper, www.johnshopkinshealthalerts.com/white_papers/arthritis_wp/main08_landing.html, by Simeon Margolis, MD, PhD.