I'Ve Heard Heart Disease Is More Common in Rheumatoid Arthritis... Is That True?

One of the key and disturbing clinical research findings in rheumatoid arthritis (RA) has been the discovery that cardiovascular risk is markedly increased. Both heart attacks and strokes occur more commonly in [patients with RA ... and they tend to occur earlier than in the general population.

The theory to date has been that the chronic smoldering inflammation that is the mark of this illness is responsible for the development of early and aggressive atherosclerosis.

A recent study sheds a more disturbing light on this situation. It turns out that men who have a specific blood marker, the autoantibody rheumatoid factor (RF) by itself without even having rheumatoid arthritis, also have an increased risk for ischemic (atherosclerotic) heart disease.

These findings were published in the October 2007 issue of the journal Heart. (Edwards CJ, et al. Heart 2007;93:1263-1267).

While RF is strongly associated with rheumatoid arthritis, it is also present in up to 15% of all adults. Rheumatoid arthritis patients who have RF in their blood are at particularly increased risk for heart disease, compared with RA patients who do not have RF.

To determine whether RF might identify people in the general population at increased risk for ischemic heart disease, Dr. C. J. Edwards and his group from Southampton General Hospital studied 1,156 elderly men and women.

The investigators found that 16.2% of the men and 12.4% of the women were positive for RF. The presence of RF was associated with about a 3-fold greater likelihood of ischemic heart disease in men.

This increased risk could not be explained by traditional risk factors for ischemic heart disease, according to the scientists.

There was no significant association between RF and ischemic heart disease in women.

The conclusion from the researchers is that the study "lends support to the importance of inflammation in atherosclerosis and suggests that autoimmune processes may be involved. In addition, it raises the intriguing possibility that RF may have a direct role in the pathogenesis of ischemic heart disease in some subjects."

Author''s note: The early studies that indicated the likelihood of an increased cardiovascular risk in RA have proven, unfortunately, to be all too true. RA is a disease that can lead not just to disability and crippling but to premature death as well. Long term studies evaluating the effectiveness of newer biologic treatments in reducing cardiovascular death are underway and the results will be interesting to see.

Nathan Wei, MD FACP FACR is a rheumatologist and Director of the Arthritis and Osteoporosis Center of Maryland. He is a Clinical Assistant Professor of Medicine at the University of Maryland School of Medicine. For more info: Arthritis Treatment