What Rheumatoid Arthritis Does to Your Heart

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When you have rheumatoid arthritis (RA), you’re sure to notice any painful, swollen joints. But it’s important not to overlook what’s happening in the rest of your body, too, including your heart and blood vessels.

Higher Risk of Heart Disease

For people with RA, a disease that causes joint inflammation, the risk of dying from cardiovascular disease is up to 50% higher than in the general population. In fact, cardiovascular disease is actually the number one cause of premature death in people with RA.

That doesn’t mean you’re automatically doomed to have a heart attack, however. Even if you have RA, there’s a lot you can do to reduce your risk. Two keys to protecting your heart are reducing body-wide inflammation and choosing a heart-smart lifestyle.

Inflammation and Atherosclerosis

RA inflames the joints, but its effects don’t stop there. People with RA may also have more widespread inflammation throughout their bodies, which can affect the body’s organs and tissues.

Long-lasting inflammation can damage the endothelial cells that line the insides of arteries. The damage promotes the development of plaque—a buildup of cholesterol, fat, calcium, and other substances in the blood. Over time, plaque hardens and narrows the arteries, limiting the flow of oxygen-rich blood. This condition, known as atherosclerosis, can cause heart disease if it occurs in the arteries to the heart.

Enough to Give You a Heart Attack

RA has been linked to several kinds of heart problems, including:

  • Atrial fibrillationThis condition, the most common type of heart rhythm problem, occurs when the upper chambers of the heart beat very fast and irregularly. Left untreated, it can lead to a stroke or heart failure. People with RA have an increased risk of developing atrial fibrillation.

  • Heart attack. Plaque sometimes builds up inside arteries that supply the heart, narrowing them. The presence of plaque increases the chance that a blood clot will form. If a piece of plaque or a blood clot blocks the flow of blood to the heart, the result is a heart attack. The risk of having a heart attack is up to two times higher in people with RA, compared with those without RA.

  • Heart failure. This condition occurs when the heart is unable to pump enough blood to meet the body’s demands. People with RA are more likely than those without RA to develop heart failure and die soon afterward.

  • Pericarditis. In this condition, the membrane enclosing the heart becomes inflamed, leading to chest pain and sometimes disrupting the heart’s normal rhythm. Chronic RA inflammation may cause long-lasting pericarditis.

The Ticket to a Healthier Ticker

In general, the more severe your RA, the greater your chance of developing heart problems. To protect your heart, it’s important to get inflammation under control. And the sooner you can do this the better, because the risk of having a heart attack goes up within the first year after being diagnosed with RA. Work with your doctor to find the arthritis treatment that’s most effective for you.

To further reduce your risk of heart problems, stay physically active, eat a balanced diet, maintain a healthy weight, and don’t smoke. Ask your doctor or a dietitian for suggestions on making lifestyle changes successfully.

High blood pressure, unhealthy cholesterol levels, and diabetes only add to your risk of developing heart disease. If you need medication to treat any of these conditions, be sure to take it as directed.

RA Medicines and Your Heart

Unfortunately, some medications used to treat RA might actually put your heart in greater jeopardy. On balance, these medications are still helpful for many people. But the risks and benefits of these medications should be carefully weighed with your doctor:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)—including diclofenac (Voltaren), ibuprofen (Motrin), and celecoxib (Celebrex)—increase the risk of heart attack, stroke, and atrial fibrillation. This seems to be less of a problem with naproxen (Aleve, Naprosyn) than with other NSAIDs.
  • Prednisone (Prednisone Intensol, Rayos) can raise blood pressure, cause weight gain, and increase heart disease risk. Taking the lowest effective dose for the shortest possible time helps reduce side effects.
  • Tocilizumab (Actemra) can raise cholesterol levels. If you take it, you’ll need to get your cholesterol checked regularly.
  • Abatacept (Orencia) can cause elevations in blood pressure. If your doctor prescribes this medication, plan to check your blood pressure regularly.

Other RA drugs can have a positive impact on cardiovascular health:

  • Hydroxychloroquine (Plaquenil) may improve cholesterol and blood sugar levels, which are risk factors for heart disease, though there is no solid evidence that heart disease incidence is actually lowered.

  • Methotrexate (Otrexup, Rasuvo, Rheumatrex, Trexall) reduces the risk of heart disease, possibly by decreasing plaque buildup in arteries.

  • TNF inhibitors—including adalimumab (Humira), etanercept (Enbrel), and infliximab (Remicade)—are a mixed bag. They help fight atherosclerosis, but they also increase the risk of heart failure.

Talk with your doctor about the heart health risks and rewards of your arthritis medication. Living well with RA isn’t just about caring for your joints. It’s also about giving your heart some much-needed TLC.

Key Takeaways

  • Rheumatoid arthritis (RA) has been linked to several different heart problems. In fact, people with RA are up to 50% more likely to die from cardiovascular disease than the general population.

  • To protect your heart, it’s important to get RA inflammation under control as soon as possible. You should also stay physically active, eat a balanced diet, maintain a healthy weight, and avoid smoking.

  • Some drugs that treat RA can have a negative effect on heart health, while other can help protect your cardiovascular health. Talk with your doctor about the heart health risks and rewards of your RA medications.

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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Oct 3

  1. Choy E et al. Cardiovascular risk in rheumatoid arthritis: recent inflammation, risk predictors and the impact of treatment. Rheumatology. 2014;53(12):2143-54.

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  7. What is Atrial Fibrillation? National Institutes of Health. National Heart, Lung and Blood Institute. https://www.nhlbi.nih.gov/health/health-topics/topics/af

  8. What Are the Signs and Symptoms of Atrial Fibrillation? National Institutes of Health. National Heart, Lung and Blood Institute. https://www.nhlbi.nih.gov/health/health-topics/topics/af/signs

  9. What is Atherosclerosis? National Institutes of Health. National Heart, Lung and Blood Institute. https://www.nhlbi.nih.gov/health/health-topics/topics/atherosclerosis

  10. What is Heart Failure? National Institutes of Health. National Heart, Lung and Blood Institute. https://www.nhlbi.nih.gov/health/health-topics/topics/hf

  11. What is Pericarditis? National Institutes of Health. National Heart, Lung and Blood Institute. https://www.nhlbi.nih.gov/health/health-topics/topics/peri/causes

  12. Rheumatoid Arthritis. National Institutes of Health. National Institute of Arthritis and Musculoskeletal and Skin Diseases. https://www.niams.nih.gov/health-topics/rheumatoid-arthritis    

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