It is a very common observation that people with arthritis such as rheumatoid arthritis or osteoarthritis are more prone to the risk of diseases related to the heart. Various studies and research on this topic have proved this as well.
There can be a variety of reasons so as to why arthritis affects the heart.
It can lead to disorders such as stroke, atherosclerosis, high blood pressure or heart failure to name a few.
People who are as a risk of these diseases can prevent it at an early age with the help of the treatment methods and by taking some precautions.
What Is Arthritis?
Arthritis is a disorder mainly observed in elderly people. It is a collection of diseases of the inflammation of various joints of the body.
Arthritis can be of several types. Till now, more than a hundred types of arthritis have been discovered. Most of these are considered as a systemic disease.
This means that they affect multiple joints at the same time rather than a single one.
The most frequently affected joints of the body are the hip, shoulder, knee and spine joints. This condition is more prevalent in women and people belonging to the older age groups.
Arthritis is characterized by inflammation, sudden flares of pain in the joint, redness and tenderness of the joint.
It makes the joint stiff and the person finds it difficult to move the affected body part.
Even though the disease is not permanently curable, it can be treated at an early age. The symptoms of the disease can also be decreased by using the medicines available in the market.
This disease can be fatal if the person is not given the required treatment on time.
How Does Arthritis Affect the Heart?
Let's learn a bit about inflammation before we explore the relationship.
What is the role of inflammation?
Inflammatory diseases increase the risk of heart disease by a significant amount.
Inflammation is a condition in which the joint becomes swollen, red, warm and painful. It is the main symptom of arthritis.
Cardiovascular disease caused because of rheumatoid arthritis can be controlled or prevented by keeping the severity of inflammation in check.
The lesser the inflammation is, the lower are the chances of the heart being affected.
Inflammation may also change the levels of lipid by altering lipid metabolism. The abnormally increased lipid levels lead to the development of various cardiovascular diseases.
How do cardiovascular diseases develop in the case of gout?
Gout or gouty arthritis is another type of arthritis characterized by the deposition of crystallized uric acid in the joints. The joints swell as a result of this.
Uric acid is found to be associated with various cardiovascular diseases such as hypertension, coronary artery disease, and preeclampsia among others.
High uric acid level along with these health conditions may develop due to factors such as high sugar intake, low birth weight which leads to obesity or genetic traits.
What effect does rheumatoid arthritis have on the heart?
The risk of developing cardiovascular disease is much higher in patients with rheumatoid arthritis than the ones without the disease.
Studies found that this is similar to the effect of diabetes on cardiovascular health.
Excess inflammation
Elevation in inflammation can be a risk factor for several heart-related conditions such as atherosclerosis.
If it is not controlled or reduced on time, it can also lead to cardiovascular death.
Cardiotoxicity of medication
The cardiotoxicity of the anti-rheumatic and anti-inflammatory drugs is not a well-researched topic.
However, most of the studies suggest that these drugs are harmful to the heart and should be used in moderation.
Increased use of glucocorticoids can damage the heart muscles, leading to heart attacks and even death.
NSAIDs (non-steroidal anti-inflammatory drugs) also weaken the muscles of the heart to a great extent. This increases the risk of myocardial infarction.
TNF alpha inhibitors affect the walls of the blood vessels which may lead to the development of heart diseases such as atherosclerosis, according to some studies.
Immune dysregulation
The various types of autoimmune arthritis such as rheumatoid arthritis involve immune cells such as cytokines which are responsible for the inflammation. An increase in these cells might promote cardiovascular disease.
Metabolic health
Arthritis affects the metabolic health, leading to the development of the metabolic syndrome. Metabolic syndrome is a collection of diseases or abnormalities associated with cardiovascular disease.
This happens mainly because of the inflammation.
Genetics
The genes of a person greatly contribute to the risk of heart diseases. Studies have shown that people with rheumatoid arthritis contained a gene HLA-DRB1, which along with the chronic inflammation posed as a risk for cardiovascular disease and even death.
How does menopause affect the disease?
Menopause is the natural downfall of the reproductive hormones of females.
This takes place after the women reach a certain age, usually somewhere between 40 and 50. Due to this, women are no longer able to reproduce.
A study was done on older women suffering from rheumatoid arthritis to see the effect of menopause on cardiovascular diseases.
It was observed that women who underwent menopause at an early age were at an increased risk of developing cardiovascular disease as compared to those who did not.
This could be primarily because of the changes in female hormones.
Does age influence the risk of heart diseases?
Age plays a major factor in determining the severity of the disease.
The risk of arthritis, which subsequently leads to cardiovascular diseases, is higher in people who cross a certain age.
A study conducted on patients with rheumatoid arthritis who were older than 50 years of age found that with an increase in age, the risk of cardiovascular disease also increases by a rate of more than 10%.
This can be prevented by taking the necessary precautions and managing the disease on time.
Which Heart Diseases Can Arthritis Lead to?
Heart attack
Myocardial infarction, or a heart attack, occurs when the heart muscles are deprived of blood rich in oxygen.
It may be caused when a blood clot blocks the flow of blood into the blood vessels.
The symptoms mainly include a feeling of tightness in the chest and arms, abnormal heartbeat, and fatigue.
This condition permanently damages the heart.
Rheumatoid arthritis leads to an increased risk of cardiovascular complications such as myocardial infarction (Heart attack), which eventually leads to death.
In order to prevent this, it is important to minimize the inflammation of the joints.
Studies have reported the incidence of silent heart attack among some people with rheumatoid arthritis.
A silent heart attack is the same as a normal heart attack, the only difference is that in this the symptoms are absent or hidden.
The electrocardiograph of people showed a severe effect of the disorder on the heart.
Stroke
A stroke occurs when the blood supply to the brain gets blocked. Due to this, the oxygen supply gets cut off and so the cells of the brain begin to die.
The brain starts to degenerate and the person starts to lose his memory and the ability to control the muscles and body functioning.
Stroke is cerebrovascular disease. It can be of three types:
Hemorrhagic stroke – It is caused by the blockage or bursting of arteries in the brain. The blood which leaks out damages the brain cells by putting pressure on them.
Ischemic stroke – This is the most common type of stroke. It is caused when the blood flow to the brain reduces due to some blockages in the artery.
Transient ischemic attack – This type of stroke is the same as an ischemic stroke, but it is temporary.
The risk of stroke is more if the person suffers from rheumatoid arthritis. Decreasing inflammation is one way to prevent stroke. It should be taken care of at the earliest possible age with the help of medicines such as DMARDs, statins, etc.
A type of stroke, ischemic stroke, can be considered as a complication of rheumatoid arthritis according to studies.
Atrial fibrillation
Atrial fibrillation is basically an abnormal or irregular beating of the heart.
Initially, this irregularity may last for short durations, but it may become more long lasting with time. It may or may not have symptoms.
The major symptoms include heart palpitations (sensation of heart beating faster than normal), pain in the chest, breathlessness, and lightheadedness.
Atrial fibrillation can lead to an increased risk of heart diseases such as stroke, heart failure, and dementia.
A recent study in Denmark found an increased incidence of atrial fibrillation among people suffering from rheumatoid arthritis. Atrial fibrillation may further cause arrhythmia or the irregular beating of the heart.
The possible reason for this risk could be diastolic dysfunction.
High blood pressure
Hypertension or high blood pressure, as the name suggests, is a condition in which the pressure of blood in arteries is persistently increased.
Although there are no visible symptoms for this, it increases the risk of other heart-related diseases in the long term.
Some of these may be a stroke, heart failure or even kidney diseases.
High blood pressure and arthritis may coexist in many cases because of endothelial dysfunction. This could be treated by an increased supply of nitrogen, which can be done with the help of some specific medicines. Naproxcinod is one such drug.
Rheumatoid arthritis can also lead to an increase in endothelial dysfunction, which could further account for high blood pressure or hypertension among people.
High systolic blood pressure is linked to rheumatoid arthritis in the sense that it increases with the increase in intake of the medicines for the treatment of arthritis.
The use of these drugs should be replaced with alternative treatment methods in order to reduce the risk of cardiovascular diseases.
Atherosclerosis
Atherosclerosis is a medical condition characterized by the narrowing of arteries to an extent where it blocks the flow of blood.
It is the root of many heart conditions such as heart attack, peripheral vascular disease, stroke, and other diseases as well.
Atherosclerosis is more common in people with rheumatoid arthritis than in those without it.
The main reason for the occurrence of this disease is chronic inflammation. Cells which are pro-inflammatory, including cytokines such as interleukins and tumor necrosis factor-alpha, are responsible for this.
Studies have found that the buildup of plaque in the arteries increases when atherosclerosis coexists with arthritis.
This progression of the disease may even lead to the rupture of the artery.
The abnormal cells of the immune system in the case of rheumatoid arthritis act as another reason for the development of atherosclerosis.
Heart failure
Congestive heart failure, or simply heart failure, is a serious health condition in which the heart is unable to pump a sufficient amount of blood in order to fulfill the body’s requirement.
The commonly observed symptoms are shortness of breath, inflammation of legs and fatigue.
It may be caused by a heart attack or some other cardiovascular disease as well as due to excessive intake of alcohol.
The main cause of mortality or death among patients with rheumatoid arthritis is congestive heart failure.
Getting rid of the risk of heart failure may decrease the mortality rate in such patients and improve their living conditions.
One study reported that people with rheumatoid arthritis were found to have an escalated risk of congestive heart failure if they were rheumatoid factor positive. Rheumatoid factor is a protein produced by the immune system of the body.
It is responsible for attacking the healthy tissues of the body.
Mortality
Mortality or death can also be associated with the risk of heart disease in patients with arthritis.
In some studies, the risk of death was observed to be significantly higher in people suffering from rheumatoid arthritis than those without the disease.
This was mainly because of the negative effect it has on the heart.
Presence of rheumatoid factor in the blood increases this risk further.
What Are The Risk Factors Of Developing Heart Disease In Arthritis?
Heart diseases may develop in patients with arthritis as a result of various risk factors.
Smoking
Smoking increases the risk of cardiovascular disease. Studies report that people suffering from rheumatoid arthritis who smoke regularly have an increased incidence of heart diseases.
Body weight
A study conducted on African women suffering from rheumatoid arthritis revealed that they were at a higher risk of developing cardiovascular diseases than those without it.
This could be because of the association of obesity with inflammation. A high BMI or body weight increases the level of cytokines which account for inflammation.
Inactivity
According to studies, inactivity or not being physically active is linked to an increase in cardiovascular disease in patients with rheumatoid arthritis.
Exercise and other forms of physical activity help to reduce the risk of this disease and also improve arthritis.
Further, a sedentary lifestyle also leads to obesity.
Medicines
Though most of the medicines prescribed for the treatment of arthritis can lead to the development of the cardiovascular disease, studies claim that a disease modifying anti-rheumatic drug (DMARD), methotrexate, can have the opposite effect.
This means that it shows a cardioprotective effect on the body. It reduces inflammation and prevents atherosclerosis, protecting the patient in the long term.
Genes
Some genes linked with the production of inflammation and metabolism may play an important role in the development of cardiovascular disease in people with rheumatoid arthritis.
How to Prevent Heart Diseases Linked With Arthritis?
Eat healthy foods such as fruits and vegetables.
A healthy diet consists of the intake of lean or low-fat protein, a moderate amount of carbohydrates and whole grain items. Nutrients such as fats, salt, and sugar in excess should be avoided.
Exercise plays the most important role in the improvement of any disease. It prevents the risk of several other health conditions as well.
The physical workout should be made a part of the daily routine. Walking, running and stretching are some simple exercises that can do wonders for the health.
Smoking should be avoided at all costs. It does not have any health benefit. Instead, it causes a variety of diseases apart from cardiovascular disease and arthritis, mainly including cancer.
Statins are a type of drugs known to have a lipid-lowering effect on the body.
A study conducted on patients with rheumatoid arthritis who had suffered a heart attack in the past found the effect of statins on the body.
People were observed to have a decreased level of low-density lipoprotein (LDL) cholesterol. This is also known as the “bad” cholesterol.
Another reason for using statins for the prevention of coronary heart disease is that it is better than controlling inflammation.
Keeping the inflammation levels low for a long period of time reduces the chances of coronary heart diseases, but this is a difficult method.
An easier way for this is to use statins.
Fish oil contains omega-3 fatty acids, which have many positive effects on the body.
They improve cardiovascular disease significantly by reducing the levels of low-density lipoprotein (bad cholesterol). It also helps in the treatment of arthritis.
Conclusion
Now that we know how closely heart diseases are linked with various types of arthritis, it is essential that we prevent it before the elevation of both the
conditions.
We should always consult a doctor before taking any medicine for arthritis, as it may increase the risk of various heart-related diseases.
A good diet along with moderate physical activity is important in order to control and improve the disease.