Arthritis and Heart Disease

Contributed by John A Rumberger, PhD, MD, FACC

Patients with rheumatoid arthritis, psoriatic arthritis, or psoriasis are at an increased risk of major adverse cardiovascular events when compared with the general population, according to findings from a large cohort study.

All three diseases had statistically similar risks for major adverse cardiovascular events (MACE) after adjustment for age, gender, and traditional CV risk factors as recently reported (Ann. Rheum. Dis. 2014 Oct. 30)

The risk of any cardiac related event was higher in patients with PsA not prescribed a DMARD (hazard ratio, 1.24; 95% confidence interval, 1.03-1.49). This risk was elevated in RA patients both with DMARD prescriptions (HR, 1.58; 95% CI, 1.46-1.70) and without (HR, 1.39; 95% CI, 1.28-1.50). Patients with severe psoriasis who were prescribed a DMARD had an HR of 1.42 (95% CI, 1.17-1.73), whereas psoriasis patients not prescribed a DMARD had an HR of 1.08 (95% CI, 1.02-1.15).The investigators used data from the Health Improvement Network, a U.K. primary care medical record database, and compared the number of cardiac related events (myocardial infarction, stroke, and sudden cardiac death) that occurred during a mean 5 years of follow-up in 41,752 patients with rheumatoid arthritis (RA), 8,706 with psoriatic arthritis (PsA), 138,424 with psoriasis, and 81,573 age and gender matched controls – who did not have any of these conditions. There was significant interaction between disease-modifying anti-rheumatic [anti-inflammatory] drug (DMARD) use and disease group (P < .001 for MACE and two components, CV death and stroke; and P = .01 for MI).

The results highlight a need for improved screening and management of traditional CV risk factors in patients with inflammatory diseases, the researchers said.

Study limitations included not being able to measure disease severity or the use of over-the-counter NSAIDs, as well as having few records on biologic medications and possibly missing DMARD prescriptions.

John A Rumberger, PhD, MD, FACC comments:

This observational study is yet another indicator that patients with a variety of auto-immune diseases are at increased risk for heart and vascular related events.  Prior studies have noted the increased risk of vascular disease not only as above with rheumatoid arthritis [not to be confused with degenerative ‘wear and tear’ arthritis] and psoriatic arthritis but also Lupus, Scleroderma, and a variety of inflammatory bowel diseases [such as Crohn’s Disease and Ulcerative Colitis].

The underlying factors for the development of heart and vascular plaque in the coronary arteries, the carotid arteries, and the aorta is inflammation mitigated by genetics as well as the interplay of these genetics with other factors such as obesity, smoking, and abnormal cholesterol.  The same is true for the variety of auto-immune diseases that increase inflammation throughout the body and are treated with a variety of anti-inflammatory medications.  Indeed better control of these auto-immune diseases will likely result in further lowering of the overall cardiovascular risks.

My own observations from our clients at The Princeton Longevity Center indicate generally earlier and more diffuse atherosclerotic plaque formation in those with long standing auto-immune disorders, as evidenced from the heart and vascular CT scans.  In such individuals an aggressive program aimed at those ‘modifiable’ cardiovascular risk factors is necessary.