Women with rheumatoid arthritis (RA) may have a higher risk of heart attack according to a new study published in the February 17, 2003 rapid access issue of Circulation: Journal of the American Heart Association.
Several studies have made links between RA and increased rates of heart disease because inflammation – a key component of arthritis – is thought to contribute to fatty build up in the blood vessels, one of the known causes of a heart attack. Abnormal T-cells – important cells that modulate inflammation – and elevated inflammatory markers like C-reactive protein (CRP) are found in both conditions.
The findings demonstrate RA should be a recognized marker for increased risk of a heart attack, says Daniel H. Solomon, M.D., M.P.H., assistant professor of medicine in the divisions of pharmacoepidemiology and rheumatology, immunology, and allergy at Brigham and Women’s Hospital in Boston.
“It would be prudent to consider aggressive cardiac preventive measures in patients with RA to address coronary heart disease risk factors,” he said.
The relationship was studied by using the database from the Nurses’ Health Study, a prospective community-based study of 121,700 women. The nurses were between ages 30–55 years when they completed the baseline health and lifestyle questionnaire in 1976. These women are sent questionnaires every two years to update their personal information. The current study gathered data through 1996 and excluded women who reported RA, cardiovascular disease and cancer at baseline.
The researchers attempted to contact each of the 7,786 people who self-reported having RA between 1978 and 1996 to confirm the diagnosis based on standard criteria. From their responses, charts were reviewed for 2,170 participants.
“Our estimate of the risk of heart attack is based on a very conservative estimate of who actually has rheumatoid arthritis,” Solomon says.
The researchers confirmed the diagnosis of RA in 527 women. There were 2,296 heart attacks and 1,326 strokes among them.
“Women with rheumatoid arthritis have a two-fold increased risk of heart attacks compared with women without rheumatoid arthritis,” says Solomon. The risk of stroke is similar in both groups (about 1.48 times). The association remained even after adjusting for known and potential cardiovascular risk factors. In addition, those with RA for at least 10 years had three times the risk of heart attack compared to women without RA.
The average age of women with RA was slightly higher than the age of those without. The frequency of hypertension, diabetes and high cholesterol was comparable. Women with RA were more likely to have a parental history of heart attack before age 60. Their body mass index was slightly less and their physical activity levels were significantly lower. They smoked more, drank alcohol less and more of them took Hormone Replacement Therapy.
Other possible links include the reduced physical activity that often results from the discomfort of RA medications taken for RA and varying use of cardiovascular prevention for patients with RA.
Researchers encourage further examination of whether early treatment of RA with disease-modifying antirheumatic drugs may reduce the risk of heart attack.
RA is the most common autoimmune disease. It affects about 2.1 million Americans, 1.5 million of whom are women. One of the most common forms of arthritis, it’s characterized by inflammation of the lining of joints and other internal organs, resulting in pain, stiffness, swelling and loss of movement.