Cardiovascular Disease

Cardiovascular disease is one of the more common comorbidities associated with RA. The prevalence of a range of cardiovascular conditions is increased in patients with RA, including myocardial infarction (MI or heart attack), stroke, congestive heart failure, ischemic heart disease, and vascular disease.1

Heart disease in people living with rheumatoid arthritis

Patients with RA face increased risk of death compared with the general population from a variety of cardiovascular events. A large study conducted in Rochester, Minnesota examining health outcomes in men and women with RA over a period of 40 years found that this group was 1.27 times more likely to die from cardiovascular disease than their non-RA counterparts (P<0.001). The same study found an increased overall rate of mortality (compared with the general population). Cardiovascular disease accounted for almost half of this elevated risk. Compared with the general population, patients with RA were more than 3 times as likely to have a recognized MI and to experience hospitalization and 5 times more likely to have a “silent” or unrecognized MI. Additionally, RA patients were significantly more likely to have congestive heart failure, with a rate of 34% for the RA group over a 30-year period, compared with 25% for the non-RA group.2,3


Mortality rates in those living with RA increase the longer they live with RA


Cardiovascular risk in women with RA

Results from the Nurses Health Study, a study that included over 100,000 participants, showed women who had had RA for 10 years had 3 times the risk for MI compared with women without RA. Overall, women with RA were over twice as likely as their non-RA counterparts to have an MI. Additionally, the RA group was 1.5 times as likely to have a stroke.4


Incidence and risk for MI and stroke in women with and without RA

RA group
Non-RA group
Myocardial infarcation
Incidence per 100,000
Relative risk
>2.0 vs non-RA
Incidence per 100,000
Relative risk
1.5 vs non-RA


How can I reduce my risk of heart disease?

If you have RA, a number of factors can increase your risk for developing cardiovascular disease. These include hypertension, diabetes, high cholesterol, smoking, and obesity. Additionally, inflammation associated with RA appears to increase risk for development of cardiovascular disease. You can lower your risk for cardiovascular disease by not smoking, controlling your blood pressure and cholesterol, keeping your blood sugar in a safe range, and keeping your weight down.1

Exercise, diet, and medicine can help you achieve all these goals. If your blood pressure and/or cholesterol are high, there are a variety of medications that can help you lower either of these cardiovascular risk factors. Talk to your doctor about your options for treating these health conditions.

A heart healthy diet can also help you achieve your health goals. 2010 USDA Dietary guidelines stress the importance of maintaining a balance of caloric intake over time to achieve and stay at a healthy weight and to focus on intake of nutrient-dense foods and beverages. This includes limiting sodium and avoiding foods that contain too much fat, sugar, or refined grains. A healthy diet emphasizes consumption of “vegetables, fruits, whole grains, fat-free or low-fat milk and milk products, seafood, lean meats, eggs, beans, peas, and nuts and seeds.”5

When it comes to inflammation associated with RA and its contribution to cardiovascular disease risk, the good news is that you can lower this risk factor, as well. By controlling RA inflammation using the proper treatment, you can dramatically decrease your risk for cardiovascular disease. In one study where RA patients received the disease-modifying anti-rheumatic drug (DMARD) methotrexate, the risk of dying from a cardiovascular event was lowered by 70%.1

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Written by: Jonathan Simmons | Last reviewed: September 2013.