Rheumatoid arthritis linked to heart disease

Editor's note: This article is part of a series to run over the next few months on heart disease and women.

The American Heart Association provides a simple risk assessment tool to determine your risk of heart disease, the No. 1 killer of women in our nation. Check out www.americanheart.org or call 336-7005 to request your free women's heart kit.

Rheumatoid arthritis is a chronic debilitating arthritis that is driven by inflammation in the joints and other parts of the body, including blood vessels. It affects all races worldwide, and has a 3 to 1 female to male ratio. Being the most common autoimmune disease, it affects 2.5 million Americans.

There's been a growing body of evidence in recent literature linking rheumatoid arthritis and heart disease, the leading cause of death in adult Americans.

New data from the Nurses' Health Study of more than 11,500 patients with rheumatic diseases found that women with rheumatoid arthritis have a 2-fold higher risk for a heart attack.

Those who had rheumatoid arthritis for at least 10 years had three times the risk for heart attacks compared with women without rheumatoid arthritis, noted Dr. D. H. Solomon at Brigham and Women's Hospital in Boston.

A Swiss study by Lorenz Fischer looked at data collected from 40,000 patients from the United Kingdom general practice and found that fatal heart attacks were more than doubled in rheumatoid arthritis patients.

Dr. Douglas Watson, an epidemiologist, looked at the same data and added that patients with rheumatoid arthritis have a 40 percent greater chance of suffering a mild heart attack or a stroke. If a rheumatoid arthritis patient also has high cholesterol, then the risk increases 7-fold.

How can rheumatoid arthritis and heart disease be related? Rheumatoid arthritis is driven by many inflammatory processes. Recent data also shows that heart disease and atherosclerosis are also driven by inflammatory processes after injury to blood vessels.

A quote from my publication in Arthritis and Rheumatism, 2003: "There are surprising similarities in the inflammatory/immunologic response observed in atherosclerosis, unstable angina and rheumatoid ar- thritis. These include activation of immune cells (macrophages, T-cells) against the host, leading to increased levels of inflammatory parameters.

"The cellular interactions in atherosclerosis share many properties with those in chronic inflammatory diseases, such as rheumatoid arthritis. Having one inflammatory condition such as rheumatoid arthritis can often predispose to another inflammatory condition like heart disease."

Therefore, controlling inflammation can lower the risk for heart disease. Early, aggressive treatment of rheumatoid arthritis can significantly decrease the disability of the disease and the associated cardiovascular impli- cations.

The use of anti-inflammatory medications such as aspirin and cholesterol-lowering medications such as statins have been found to be cardio-protective.

Drs. McInnes and McCarey in the United Kingdom reported in their study that adding a statin (for cholesterol) to disease-modifying anti-rheumatic drugs (for rheumatoid arthritis) had significantly reduced disease activity and inflammatory parameters in patients with rheumatoid arthritis.

They also noted that statin therapy mildly reduced swollen joints, compared to a placebo.

The overall message is that rheumatoid arthritis is a risk factor for heart disease. If treated early and aggressively with appropriate medications and lifestyle modifications - diet, appropriate weight loss, exercise and stress reduction - heart disease risk, the leading cause of death, is reduced.

Dr. Ali Bazzi is a board certified rheumatologist in private practice full time with the Arthritis Center of Yuma, 3250 S. 4th Ave., Suite F. He is a member of the medical staff of the Yuma Regional Medical Center. The Arthritis Center of Yuma phone number is 314-1200.

BULLET POINTS

RHEUMATOID ARTHRITIS HAS 2-FOLD INCREASE IN HEART DISEASE.

RHEUMATOID ARTHRITIS AND HIGH CHOLESTEROL HAVE A 7-FOLD INCREASE IN HEART DISEASE.

TREATING RHEUMATOID ARTHRITIS EARLY, EATING A HEART-WISE DIET, EXERCISE AND STRESS MANAGEMENT CAN REDUCE RISK OF HEART DISEASE.

GENERALLY, WHATEVER DIET IS GOOD FOR YOUR HEART IS ALSO GOOD FOR YOUR JOINTS.