Arthritis and heart disease linked:

At the end of the largest study of its kind to date, researchers have concluded that rheumatoid arthritis in women may double their risk of heart attacks.

While not as common as osteoarthritis, rheumatoid arthritis is a more severe type of joint disease affecting about 2.1 million people in the United States, most of them women.

“We examined the rates of heart attack and rheumatoid arthritis in more than 114,000 women and found that there appears to be a strong correlation between the two,” says Daniel Solomon, assistant professor of medicine at the Harvard Medical School. “There is no reason to believe that this relationship would not be seen in men as well. These results indicate that both physicians and patients should recognize rheumatoid arthritis as a marker for increased heart attack risk, along with high blood pressure, high cholesterol, obesity, and other warning signs.”

Osteoarthritis results from wear and tear on joints and usually occurs in middle age. Rheumatoid arthritis is the most severe type of inflammatory joint disease wherein certain blood cells, which protect people without the disease, attack and destroy the body’s own tissues.

Apparently, the longer women suffer from rheumatoid arthritis, the higher their risk. Women who had the disease at least 10 years showed a threefold increased risk of heart attack, the country’s leading killer of women, compared with women without the painful and debilitating disease. No such association was found with stroke.

The study was done at Brigham and Women’s Hospital, a Harvard research and teaching facility, and reported in the March 11 issue of Circulation, a journal published by the American Heart Association. The report notes that another study, done in Canada, found people with rheumatoid arthritis died an average of 17 years earlier than expected for the Canadian population. Solomon and his co-researchers comment that several other studies have concluded, as they did, “that rates of heart and blood vessel disease increased for patients with rheumatoid arthritis, possibly explaining the reduced life span.”

Common causes

The Brigham and Women’s team believes that inflammation may be the common catalyst for both maladies. Inflammation is accompanied by an accumulation of white blood cells that protect the body from invaders like viruses and other germs. In rheumatoid arthritis, these same blood cells destroy rather than protect and repair. “Several new lines of evidence suggest that atherosclerosis has an important inflammatory component,” Solomon notes.

Atherosclerosis involves a thickening of artery walls, narrowing the vessels and impairing or blocking blood flow to the heart.

“Given this possible shared pathway, future research will need to determine whether earlier treatment of arthritis with anti-inflammatory drugs may also reduce the risk of heart attacks,” Solomon says. Potent drugs, such as methotrexate, used to treat rheumatoid arthritis, are associated with a reduced risk of heart disease deaths.

Other links between the two diseases include reduced physical activity often forced on people by arthritis. Joint pain may also hinder other measures recommended for preventing heart disease, such as weight control and low cholesterol. Additional studies are needed to understand the relationship between blood pressure and cholesterol-lowering drugs on the one hand and anti-arthritis drugs on the other, say the researchers.

“Our study indicates that it would be useful to examine how drug and lifestyle factors might reduce the risk of heart and blood vessel disease in high-risk rheumatoid arthritis patients,” Solomon says. “It may be that the disease process underlying rheumatoid arthritis explains only part of its relationship with heart attacks, and that lack of adequate preventive care for heart disease contributes to the risk. Therefore, we believe it would be prudent to consider aggressive cardiac preventive measures in patients with rheumatoid arthritis. In addition, it would be useful to examine whether early treatment with anti-rheumatic drugs might reduce the future risk of heart attacks.”