Cardiovascular Disease

Reviewed by: HU Medical Review Board | Last reviewed: April 2021

Heart disease is also called cardiovascular disease. Cardiovascular means heart (cardio) and blood vessels (vascular). One in 4 deaths in the United States is caused by heart disease.1,2

People with rheumatoid arthritis (RA) have a 50 to 70 percent increased risk for heart disease than those without RA. Problems with the heart and blood vessels affect various parts of the body. These problems appear with different symptoms and might be diagnosed differently from person to person.1,2

What parts of the body are affected?

Disease of the heart and vessels can affect many parts of the body. The most common areas affected include:3

  • Heart
  • Brain
  • Kidneys
  • Arms and legs

Types of heart disease

There are many different types of heart disease. Some of the most common types include:1,3

Coronary artery disease

Coronary artery disease (CAD) is the most common form of heart disease. It is the leading cause of death in the United States and worldwide. CAD develops when fat and cholesterol deposits, called plaque, build up in the arteries (atherosclerosis). This makes the arteries more narrow and the blood vessel walls thicker and less flexible.3-7

Heart attack

A heart attack occurs when the blood to the heart is blocked, often due to plaque build-up in the arteries and CAD. This decreases or stops oxygen and nutrients to the heart. The risk of heart attack is higher in those with RA. Women with RA are up to 2 times more likely to have a heart attack than women without RA.7,8

Heart failure

Heart failure occurs when the heart is unable to pump enough blood that the body needs. Sometimes, the heart cannot fill with enough blood. Other times, the heart cannot pump with enough force to move the blood through the body. Heart failure is also known as congestive heart failure (CHF).9

Those with RA are at an increased risk for developing heart failure. Inflammation and side effects from RA drug therapy appear to be related to this increased risk.10


A stroke occurs when the blood to your brain is blocked, preventing oxygen and nutrients to the brain. If you have RA, your risk of stroke is higher.11

Peripheral vascular disease (PVD) and peripheral artery disease (PAD)

The arteries and veins that carry blood throughout your body are collectively your vascular system. Any disease of the vascular system outside of the heart is known as peripheral vascular disease (PVD).12

Peripheral artery disease (PAD) is a type of PVD. Veins carry oxygen-rich blood from the rest of the body to the heart, while your arteries bring this blood from the heart to the rest of the body. PAD occurs only in the arteries, slowing blood flow return. This causes the arms and legs to suffer from the decreased blood supply. PAD is caused by a build-up of plaque in the arteries.12

Along with the traditional risk factors for PAD, those with RA who take steroids are at an increased risk for this type of heart disease.11

How are RA and heart disease connected?

The common connection is inflammation. Short-term inflammation is a good thing. You may recognize this type of inflammation with visible symptoms – redness, swelling, bruising, and pain. Short-term inflammation allows your immune system to repair itself from injury or disease.13

But too much inflammation can lead to problems. Long-term (chronic) inflammation is the driving force behind many chronic diseases. Your body is on high alert at all times, which makes healing more difficult. Doctors think long-term inflammation from RA may increase fatty plaque in the blood vessels and damage the lining of them.13

Another reason why heart disease and other heart problems are connected to RA is lifestyle habits. High blood pressure, high cholesterol, and smoking are common risk factors for heart disease. Nearly half of all Americans have at least 1 of these risk factors. This makes heart disease common among the general population as well. For those with RA, having any of these additional risk factors increases the risk of developing heart problems.1

Signs and symptoms

Signs and symptoms of heart disease vary depending on the type and the area of the body affected. Early or mild disease may not have symptoms. Sometimes, heart disease may be found at a routine visit to your doctor.14

Heart attack

The most common signs of a heart attack include:14

  • Squeezing or pressure felt in the chest, shoulders, arms, neck, jaw, or back (angina)
  • Heartburn
  • Sweating
  • Dizzy
  • Lightheaded feeling


Symptoms of PAD include those related to decreased blood flow, mainly to the legs and feet:14

  • Pain
  • Numbness
  • Weakness
  • Cold arms and legs


Symptoms of stroke depend on the severity and type. The most common symptoms include:15

  • Weakness on 1 side of the body
  • Facial drooping
  • Slurred speech

Heart failure

Common signs of heart failure include:9

  • Trouble breathing
  • Fatigue (tiredness)
  • Swelling of the ankles, feet, legs, belly, and veins of the neck


Many tests may be ordered. Diagnosis depends on your symptoms but may include:16

  • Physical exam
  • X-rays or imaging
  • Lab tests to check blood levels for heart damage or signs of infection
  • Electrocardiogram (ECG), a device that records the electrical activity of the heart

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