If you have rheumatoid arthritis (RA), you may be at more than twice the risk of having a cardiovascular event (CV) when compared with the general population. People with RA were also found to be at higher risk for CV than those who have diabetes. Findings suggest that systemic inflammation found in RA may be an independent contributor to CV risk.
Results published in the Journal of Rheumatology compared data from 2 cohorts of patients in the Netherlands. The purpose was to evaluate cardiovascular risk in people with RA as compared to people with diabetes and the general population.
How RA inflammation affects heart health
Rheumatoid arthritis is a chronic autoimmune condition with the hallmark symptoms of joint inflammation, pain, stiffness, and swelling. In RA, the immune system doesn’t function normally and can attack healthy joint tissue. The areas most often affected are synovial joints, the hip, elbow, hands, feet, knees, and shoulders.
Other factors that influence heart health
Inflammation due to RA can also increase the risk of cardiovascular events that result from narrowed or blocked blood vessels, heart attack, chest pain (angina) or stroke. Having hypertension, diabetes, high cholesterol, smoking, and being overweight are also cardiovascular risk factors.
Research on systemic inflammation and cardiovascular events
There has been limited long term follow-up research investigating the risk of cardiovascular events in people with rheumatoid arthritis.2 In order to analyze the influence of systemic inflammation on CV risk, the researchers from The Netherlands set out to assess the risk for incident cardiovascular disease in people with RA, compared with people with diabetes and the general population.
Looking at heart disease in different groups
These scientists looked at two study groups. One referred to as the CARRÉ cohort, included patients ages 50 to 75, diagnosed with RA between 1989 and 2001. 353 patients with RA were enrolled and prospectively followed over a period of 15 years. The follow-ups took place in years 3, 10 and 15 after the study began.2 An earlier study evaluated The Hoorn cohort which contained a random selection of 2484 adults in the same age group who participated in an “extensive and repeated” CV screening program.
A noted study limitation was that the information collected for the Hoorn cohort was collected more than 10 years earlier than the CARRÉ cohort, at a time when the definition of diseases, and disease assessment and management best practices, may have been different, and the use of certain drugs may not be consistent with current clinical practice.2
Systemic inflammation increases risk for cardiovascular events
This study looked at collected demographic data, medical and family histories, medication use, and data on a variety of rheumatoid arthritis-specific markers and classic cardiovascular risk factors. Evaluation of numerous factors including disease activity, evidence of C-reactive protein, smoking status, blood pressure, body mass index (BMI), and cholesterol were included.
Risk adjustments were made taking into account age and gender. After adjustment for traditional CV risk factors, the findings suggest that systemic inflammation is an independent contributor to CV risk.2
Researchers found that cardiovascular event hazard ratios increased in patients with RA and in patients with diabetes compared with participants without diabetes. The risk was even higher for cardiovascular events in people with both RA and diabetes.2
Cardiovascular Risk in Rheumatoid Arthritis Higher Than in Type 2 Diabetes. Available at:
https://www.rheumatologyadvisor.com/home/topics/rheumatoid-arthritis/cardiovascular-risk-in-rheumatoid-arthritis-higher-than-in-type-2-diabetes/. Accessed July 1, 2019.
Agca, R., Hopman, LHGA, Kaan, KCJ et al. Cardiovascular Event Risk in Rheumatoid Arthritis is Higher than in Type 2 Diabetes: a 15 Year Longitudinal Study. Available at: http://www.jrheum.org/content/early/2019/05/13/jrheum.180726. Accessed July 1, 2019.