20 Facts About Rheumatoid Heart Disease
This is part 2 of yesterday’s post Rheumatoid (Arthritis) Heart Disease about the history and uniqueness of the heart disease of Rheumatoid Arthritis. It’s important to realize…
Rheumatoid heart disease is part of the Rheumatoid disease. It is not just…
- RA increasing a person’s chances of heart disease.
- RA making heart disease worse.
- RA patients being more likely to die if they get heart disease.
20 Specific findings about Rheumatoid heart disease
- Increased RA mortality can largely be attributed to increased cardiovascular death.
- RA patients are twice as likely to experience unrecognized heart attacks and sudden cardiac deaths.
- The risk of heart attack is already there at the time a Rheumatoid Arthritis diagnosis is first made.
- Several traditional cardiovascular risk factors were found to behave differently in RA patients.
- Cardiovascular risk scores for the general population may underestimate the risk for RA patients.
- Optimal control of cardiovascular risk factors is important, but not sufficient in RA patients. RA-specific cardiovascular risk prediction tools are needed.
- Dr. Maradit Kremers: “Something else is going on. It could be that rheumatoid arthritis and heart disease have a common origin.”
- Data support the hypothesis that a blood-based immunologic signature (IL-17) may be useful to identify patients at risk for adverse disease outcomes such as heart failure.
- People with RA who experience sudden cardiac death are less likely to have had a history of chest pain than those without RA.
- Increased cardiac events in RA patients could not be explained by an increase in traditional heart disease risk factors such as elevated cholesterol, blood pressure and body mass index, diabetes, and alcohol abuse.
- Heart disease can remain silent in those with rheumatoid arthritis. Regular cardiac checkups are important, as is lowering traditional cardiac risk factors, such as taking care of blood pressure and cholesterol and quitting smoking.
- MI (myocardial infarction) risk increases rapidly following RA diagnosis, suggesting the importance of additional mechanisms other than atherosclerosis.
- Neither CRP nor swollen joints were predictors of heart disease progression, but joint count (number of joints affected) was.
- A protein called NT-proBNP was shown to be a “powerful predictor” of cardiovascular risk in Rheumatoid Arthritis patients taking certain NSAIDs.
- Baseline C-reactive protein level was not associated with cardiovascular event rates in the MEDAL analysis.
- Comprehensive cardiac magnetic resonance imaging (cMRI) detects abnormalities in RA patients with no known cardiac symptoms.
- Internal carotid artery IMT had a higher predictive power for the development of cardiovascular events than the common carotid artery.
- Atherosclerosis can advance while RA symptoms are quiet.
- Some biologics may slow thickening of arteries.
- Prednisone decreases inflammation, but is associated with increased plaque.
Note: There are 14 posts on this site with the Tag “Rheumatoid Arthritis and heart.”
Additional sources:
- Rapid increase in myocardial infarction risk following diagnosis of rheumatoid arthritis amongst patients diagnosed between 1995 and 2006
- Heart disease and rheumatoid arthritis: understanding the risks
- Cytokine Response Profiling Identifies An Immunologic Signature of Myocardial Dysfunction in Rheumatoid Arthritis
- Mayo Clinic Finds Rheumatoid Arthritis Patients At Higher Risk For Unrecognized Heart Disease And Cardiac Sudden Death
- NT-proBNP Is a Predictor of CV Risk in Arthritis Patients Taking NSAIDs
- Assessment of myocardial abnormalities in Rheumatoid Arthritis using a comprehensive cardiac magnetic resonance approach
- Role of carotid ultrasonography in the evaluation of cardiovascular risk in patients with Rheumatoid Arthritis
- Rheumatoid Arthritis May Raise Risk of Blood Vessel Plaque; Certain medications seem to lessen or increase buildup, suggests study
- Longitudinal Predictors of Progression of Subclinical Carotid Atherosclerosis in Rheumatoid Arthritis
- Rheumatoid Arthritis News Articles, Volume 1
Recommended reading
- Rheumatoid Arthritis News Articles Vol.4: Lifetime Risk of RA, Home RA Tests, Atherosclerosis & RA
- Easier Said Than Done: Simple Things That Seem Impossible
- Problems with Preventive Care and Rheumatoid Arthritis Mortality
I set my appointment up with my primary doctor yesterday to have this discussion exactly. Too long on prednisone and my rheumatologist states we can not ignore what impact RA has on the heart. Problem is that this is not well known or discussed. You generally have to dig to find this kind of information about the relationship of RA and heart disease. What this all speaks to Kelly is empowering yourself as a patient with as much information as possible. By doing this you become a participant in your care and treatment, not just simply along for the ride.
The valve in my left ventricle has begun to harden. I found this out from a GP, not my Rheumatologist. My rheumatologist acted like I was making things up when I told him that I had begun to experience some arrhythmia. This GP did a whole body scan. It’s some new non invasive technology that has come out of Germany. It’s called an electro interstitial scan. There are varying thoughts about its uses and results online, but I have to say I was wowed by it. It also put my mind at ease in that I now knew what I was going on with me even before I knew there was such a thing as Rheumatoid Heart disease. It is important to know and we each have a right to know what is going on with our health.
thanks for sharing this Nicole. I’m going to ask my gp about it.
Thanks again for sharing information Kelly. This is another of those things that have been kept from me over the yeaars, even though I have a long family history of heart problems. I will have to shore up my courage to ask about this, as the Dr.s seem to resent being asked about something they have not brought up.
Marilyn, I have the same problem. I’ve been scoffed at every time I ask a question so I have to talk myself into asking a question now, but I will!
I had arrhythmia for about a year with elevated heart rate. I was given a two week monitor that recorded the episodes. I the had heart ablation were they zap the part of the heart that causes the problem. It’s been four years and all has been well thus far. My mom had RA too and she died from congestive heart failure which is why we watch this carefully…ciao
Thanks for the good information Rositta. I’m so glad you are doing better!
“7. Dr. Maradit Kremers: “Something else is going on. It could be that rheumatoid arthritis and heart disease have a common origin.””
This part makes me wonder. I’ve got a congenital heart defect that was detected and diagnosed as an adult, same for one of my aunts (who we believe has EDS). My particular defect is thought to be a Connective Tissue Disease. I believe they’re related, in my case at least.
It’s just that doctors don’t know enough about the whole system of autoimmune disease. I truly believe a lot of these seemingly unrelated issues are somehow connected.
Scary! I never thought to ask my doc about heart issues. This is definitely good to know!
Very enlightening post! I don’t have R.A., I have Crohn’s Disease, but share many of the same symptoms. Keep it up! ~ Peter
I have a hard time accepting that they can tease out the various risk factors for heart disease in an RA patient. Show me an RA patient with only one risk factor.
I’m of the school that they’re all in play. From what I know of the risk factors there are 3 main ones: lipids (cholesterol), inflammation and lack of exercise. I would suspect that RA patients have a lot more circulating pro-inflammatory cytokines than a normal person. It is know that these cytokines, like IL-6, can promote atherosclerosis and plaques. Then you throw lipids in the mix and that can also promote atherosclerosis. I don’t know about most of you, but when my ankles, knees and hips are acting up I find it hard to be very active. So the heart is left without adequate exercise and regular challenges. I’ve also read that RA can also cause pericarditis or inflammation of the sack the heart sits in. I can’t imagine that that is good for the heart either. If any of you read the package inserts or warnings you get with your meds, you’ll also see that NSAIDS (naproxen, ibuprofen, celebrex, etc.) have a black box warning for heart attack and stroke. I’m sure many of you are like me and take these medicines regularly as well to relieve pain and stiffness.
So there you are, the perfect recipe for heart disease. It all seems very logical and obvious to me. So why don’t docs get it?
Thanks so much for these two articles on RA heart disease. It is very timely for me since I have been having occasional palpitations and my doc is sending me to a cardiologist to have my heart checked out. I’ve had JRA since I was 18 months old and now I’m in my 40’s. That is a long time span of damage to my body by this disease.
Hmmm – I was sitting here doing nothing much (my hips and knees are not “happy with me” at the moment) when I felt like my heart was turning somersaults for about 45 seconds. I was fine afterward, and didn’t have any pain, fainting, or anything. So I have to make an appointment with my hubby’s cardiologist and see if anything “interesting” is going on.
Thanks, as usual, for the heads-up!
Love
Elizabeth
Just curious – anyone else have a heart murmur as a child? I did and now my son does as well.
I am going to bring up my heart with gp and rheumy.
Anneke
I had a heart murmur as a child and had routine EKG’s to monitor it. I never thought about it in relation to my RA which I have now had for about 20 years. It was so long ago though, I dont remember when I didnt need the check up’s anymore or when I grew out of it and/or asthma. I just had my first Remi infusion on Friday, hoping for the best, Ive had a pretty bad RA year now.
In 2002, 11 years after my initial RA diagnosis and while fighting persistent disease progression with Remicade, prednisone, and MTX, I developed shortness of breath and chest pressure. At my doctor’s office, my rheumatologist heard a murmur in my heartbeat, ordered an EKG, and had me admitted to the hospital for possible pneumonia/ viral infection/TB…conditions I had experienced several times before. Consultations with Infectious Disease and Respiratory specialists, and treating me with a broad spectrum of antibiotics did not relieve the symptoms. Three or four days later, my condition worsening, they finally brought in a cardiologist, and then quickly transferred me to Kaiser’s larger hospital 60 miles away where their top heart specialists practice. Turns out I was in critical condition with two regurgitated heart valves that had been destroyed by rheumatoid nodules. Turns out I also had aspergillus fungus infection (unknown cause) as well as several
benign rheumatoid nodules in my lungs. After being visited by every possible doctor and nurse in
the hospital for their chance to hear a real, live, extremely-rare double valve heartbeat, I had the
open-heart surgery to replace the valves and went home a month later with ongoing home
treatment for the aspergillus.
Regular doctor visits now included appointments with a cardiologist. In 2004, a regular follow-up EKG revealed I had developed congestive heart failure/ cardiomyopathy. I was assigned a heart failure case manager and had to attend a few group “classes” to learn how to control and manage
this new condition, but I never felt it was relevant to my situation because I did not have the usual
associations of high blood pressure, narrowed arteries, lack of exercise,smoking or salt intake. My
heart failure was caused by RA, but most heart care specialists don’t acknowledge or understand
that, so I pretty much ignore the dietary advice. I now have a very good cardiologist who listens to
me, and has once or twice even given me salted chips in her exam room to try to bring my usually
very low blood pressure up toward normal! So, yeah, Heart disease is a whole different thing in RA
patients, at least for me.
And just to show that my case wasn’t a one-time freak incident, but a systemic invasion, I was diagnosed with moderate to severe sleep apnea in late 2004 ( definite heart involvement, whether
cause or result), and then two years later suffered a sudden third degree heart block that resulted in
a pacemaker. Most recently, I was diagnosed with polychondritis, another autoimmune disease that
inflames and erodes cartilage in the eyes, ears, spinal disks,heart valves, pharynx, nose, and so on.
This condition probably accounts for my uveitis, the complete erosion of my epiglottis, the two large
holes in my septum with partial nasal collapse, and maybe even my heart valves, before or now.
The point of this lengthy story is that RA is still so misunderstood by the medical profession. Most doctors have a sort of tunnel vision as to what constitutes RA, heart disease, sinus problems,
respiratory issues, and so on, and think it follows the same course, progression, and timeline in all
patients. They are not trained to look for the connections, consider alternate treatments, or call in
a different specialist or second opinion.
I’m very lucky to have found a formerly retired, highly esteemed rheumatologist who takes on just a few self-picked patients with whom he can spend up to an hour on visits and dedicates his
personal time and energy to analyze puzzling cases like mine and come up with inventive, out-of-
the-box treatment ideas. Finally, after ten years of caring for me, he knows never to doubt the possibility of RA being responsible for whatever is happening in my body.
I hope he has a chance to pass on this knowledge to the next generation of doctors. I recently told him I’d be willing to be “seen” by doctors in nearby teaching practices and hospitals to help educate them on RA progression. My biggest hope is that the next generation of RA patients will never have to experience what I have, thanks to new drugs and ongoing research. (by the way, I’m 57, in a wheelchair and retired from teaching on disability since May 2002.)
What an amazing comment June. Thank you for taking time – you have hit the nail on the head here so I hope no one misses it:
“The point of this lengthy story is that RA is still so misunderstood by the medical profession. Most doctors have a sort of tunnel vision as to what constitutes RA, heart disease, sinus problems, respiratory issues, and so on, and think it follows the same course, progression, and timeline in all patients. They are not trained to look for the connections, consider alternate treatments, or call in a different specialist or second opinion.”
This is extremely important and what I’ve tried to communicate. Thank you for your story.
I have never read any other list like this one about Rheumatoid heart disease. It represents MANY hours of reading. Obviously, as a person living w/ the disease, it’s a priority for me to learn about it. Readers also know this is how my grandfather died, as a majority of RA patients do.
I want to add to this post asap, or write another to the series. The more I read the more I learn…
More facts about Rheumatoid heart disease:
The left ventricular mass is reduced in RA.
Stiffening of tissue.
Certain heart chambers do not fill properly.
Thanks, but now I’m scared.
My father died at 81 from heart disease [not sure of exact details, but I know he was on oxygen for the last few months]. I don’t know that he had any autoimmune diseases, but would not be surprised, the more problems I discover that have an autoimmune background.
Twenty years ago I was complaining of very severe breathlessness on strenuous exercise, and had an angiogram. The DR came in to see me later and told me “You will never have a heart problem”, and we discovered the breathlessness was caused by exercise induced asthma.
Ten years later my husband had a triple bypass, and since then I have been VERY careful about diets. I have never smoked, and never drank more than 1 glass of alcohol a day [even less now due to mtx]. So heart disease was not even on my radar as a possible problem.
But at 69, I do have RAD, Sjogrens, costochrondritis and probably Reynaulds. My RAD is not ‘severe’ [so far I don’t need biologics] but it is in most of my joints. I am starting to worry that my very helpful GP will think I’m a hypochondriac. But I too will have to build up my courage to ask about this.
Thanks again Kelly.
Barbara
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