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Heart disease and arthritis: what you need to know

Doctor examines a patient's leg

Many of us know the link between heart disease and stroke, but did you know heart disease is also related to arthritis?

Studies show that having arthritis, especially rheumatoid arthritis, doubles your risk of developing a heart condition, says Dr. Jessica Widdifield, a scientist in the Holland Bone and Joint Research Program at Sunnybrook Research Institute. She leads population-based studies to improve the evaluation, care and outcomes for patients with musculoskeletal conditions.

Cardiovascular disease is also the leading cause of death in patients with rheumatoid arthritis. Researchers believe the increased risk may be due to rheumatoid arthritis as an autoimmune condition where there is ongoing inflammation. The immune system attacks the body’s own tissues and affects the synovium or lining of the joints. This causes swelling which leads to damaged bones and joints.

Inflammation in rheumatoid arthritis can then also lead to damage in other areas of the body. It contributes to hypertension (high pressure of blood against artery walls) a well-established risk factor for developing heart disease resulting in overall reduced elasticity in blood vessels and increased stiffness, specifically in arteries.

Most individuals with arthritis are unaware that they are at an increased risk of developing cardiovascular disease in relation to their condition. If you didn’t know of these connections you are not alone, adds Dr. Widdifield who is also an assistant professor at the University of Toronto’s Institute of Health Policy, Management and Evaluation. Her research team has also identified that patients are not often adequately screened for cardiovascular risk factors by their physicians. “So it’s very important that patients take a proactive role in their health,” she adds.

If you have rheumatoid arthritis or have been newly diagnosed, what can you do to be proactive about heart disease risk? Rheumatologist Dr. Shirley Lake, also a member of Sunnybrook’s Holland Bone and Joint Program, offers information that may be helpful in your discussions with your doctor:

How much exercise should I be getting?

“The Canadian Physical Activity Guidelines for adults recommends getting at least 150 minutes of moderate to vigorous-intensity aerobic physical activity weekly, in bouts of 10 minutes or more. However, if there are other existing medical conditions or if there is difficulty with weight bearing, talk to your doctor or a health care provider such as a physiotherapist who can help you tailor a plan that works. It is also beneficial to add muscle and bone strengthening activity using major muscle groups at least two days a week.”

What is a moderate weight for me to aim for?

“Some people aim for an average body-mass index of 18.5-25 kg /m2. But there are exceptions based on the amount of muscle someone may have, so it is best to use this average only as a general guideline.”

What can I do to quit smoking?

“Just asking about options is the first step. There are so many resources to help people quit – from books, helplines, counsellors, and medications. Talk to your health care provider and check out

How do I manage inflammation? Are their dietary or other things I can do?

“The not-so-good news is that diets don’t cure arthritis. The good news is that switching some foods may help you manage your arthritis better. By maintaining a healthy weight, there’s less strain on your joints and this gives you more energy. A good rule is to try to minimize calories and maximize nutrients like whole grains, fruits and vegetables, lean proteins and lower-fat dairy products. For certain arthritis conditions like gout, eating less red meat, shellfish and alcohol help prevent attacks. More vegetables and low fat dairy are beneficial. In general, talk to a dietitian about what would be beneficial.

Am I at risk for diabetes? If yes, what can I do reduce my risk?

“The prevalence of insulin resistance and type 2 diabetes is increased in patients with rheumatoid arthritis. The increased insulin resistance in rheumatoid arthritis is related to systemic inflammation. Some of the drugs used to treat arthritis, such as steroids, can increase your risk of diabetes. Early introduction of effective disease-modifying anti-rheumatic drugs such as methotrexate, hydroxychloroquine, and TNF alpha antagonists control inflammation, which may decrease insulin resistance. Other things you can do to reduce your risk of diabetes is be active, keep a healthy weight, and make healthy food choices.”

Might my medications for rheumatoid arthritis, work, or not, for helping reduce risk for a heart condition?

“Certain medications such as methotrexate that treat rheumatoid arthritis have been shown to reduce risk of heart disease**. Other medications such as NSAIDs (non-steroidal anti-inflammatory drugs), especially in the long term, can increase your risk of certain heart diseases. Certain biologics have been associated with worsening heart conditions such as heart failure. However, if these medications decrease pain and improve quality of life so that an individual can now function and exercise, they may improve their overall health. Every medication needs to be decided upon based on each person’s individual cardiac risk factors and the benefits and risk of the medication, and in consultation with your doctor.”

**A study led by Dr. Widdifield recently published in the Journal of Rheumatology evaluated the associations between use of methotrexate and risk of cardiovascular events in a cohort of 23,994 patients diagnosed with rheumatoid arthritis after age 65. The study observed a 20 percent decrease in cardiovascular events associated with these patients’ recent continuous use of methotrexate.

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Natalie Chung-Sayers