Rheumatoid Arthritis Increases Heart Attack Risk

A diagnosis of rheumatoid arthritis doubles the risk of having a heart attack within the next 10 years, according to Swedish researchers presenting their findings this week at the annual meeting of the American College of Rheumatology in San Francisco. But that disturbing news was tempered by other research which showed that medications to lower cholesterol may lower the risk and that all but one commonly used medication to treat RA also appear protective of the heart. About 1.3 million Americans have RA, according to the American College of Rheumatology. Women are twice as likely as men to be affected.

The increased risk of heart attack and other cardiovascular problems in patients with rheumatoid arthritis has long been known. "What we haven't known before is when in the RA disease process this increased risk is manifest," says Marie Gunnarsson, a doctoral student at Karolinska Institute in Stockholm, who is presenting the study findings. Her team used the Swedish RA Register to identify 7,954 patients newly diagnosed with RA and matched them with 38,913 people from the general population. They followed both groups for more than 10 years, beginning in 1995, collecting data on heart attacks, death from heart attacks, and other causes.

They computed the average rate at which the heart attacks and deaths happened. From the time of diagnosis to the first 10 years after it, the risk of heart attack and death from heart attacks nearly doubled in the RA group. At the time of diagnosis, the patients were no more likely to have a heart attack history than the control group. Gunnarsson says the new finding supports the idea that the disease itself has something to do with the development of heart problems. The inflammation that occurs with RA could be driving up the risk, she says.

In other research, investigators from the United Kingdom and the Netherlands tried to put in perspective which risk factors for RA patients are most important in predicting heart attack. Among them:

• Heart disease risk factors such as high blood pressure, smoking, and excess weight
• The use of RA medications
• The use of cholesterol-lowering medications

There has been uncertainty about which factors are most important in the risk of developing heart disease in individuals with RA. They found that those with RA had 6.49 heart attacks per 1,000 people per year, while those without had 2.96 per 1,000 people per year. The chances of having a heart attack among those with RA, overall, were less in those who took medications for RA. Researchers looked at drugs known as DMARDs (disease-modifying antirheumatic drugs) as well as prednisolone.

When they looked individually at the medications, they found that all the DMARD medications were protective of the heart but that prednisolone modestly increased the risk. When they took into account risk factors such as high blood pressure, the effects were no longer significant. The researchers also found that cholesterol-lowering medication lowered the rate of heart attack by 25%, but that blood pressure medicines had no significant effect. The presence of the rheumatoid arthritis itself seems to be the biggest risk factor for heart problems.

The research also suggests that the traditional risk factors for heart disease are very important for people with RA, he says, as well as the increased risk from having RA.