The role inflammation plays in the development of Cardiovascular (heart and blood vessel) disease has become increasingly more evident. One of the markers we use to measure inflammation in several autoimmune diseases (systemic lupus erythematosus, sjögren’s syndrome, systemic scleroderma, inflammatory myositis, psoriatic arthritis and rheumatoid arthritis), is C reactive protein (CRP). CRP is also the marker we use to identify our risk of heart disease. The exact reasons why RA has double the risk of cardiovascular (CV) disease is still being studied but the link that exists between RA and CV disease has been proven.
According to the WHO (World Health Organization), cardiovascular diseases (CVDs) are the leading cause of deaths globally – more people die from CVDs than anything else.
Cardiovascular disease “It’s the leading cause of death in the U.S.”
So… we can let this scare the pants of us! or we can make a plan together!
Evidence shows that RA can damage the lining in the artery walls just as it can also destroy the lining or the synovium of the joint
Those of us with RA … have cardiovascular risks that are different!
Studies have shown it’s more common for us (people with RA) to have plaque in our arteries or arthersclerosis and it is more likely it will develop further and at a faster rate.
We tend to visualize CV disease or heart disease as just one condition. But it’s actually a group of several conditions that affect the heart (pump) and vessels (plumbing) of the body. The system whose job it is to provide all our organs and tissues with blood, oxygen and nutrients so we can survive.
When we understand how many conditions heart disease encompasses, the seriousness of the disease becomes clear.
Cardiovascular disease is divided into two main types, Heart (pump) related and vessel (plumbing) related:
- Coronary artery disease CAD (problems involving the narrowing of the arteries or plumbing that supplies the heart)
- Heart attack/ MI myocardial infarction
- Angina/ chest pain when the heart muscle does not get enough oxygen
- Abnormal heart rhythms, or arrhythmias (problems with the heart beat) such as Atrial Fibrillation
- Heart failure
- Heart valve disease
- Congenital heart disease
- Heart muscle disease (cardiomyopathy)
- Pericardial disease
- Aorta disease and Marfan syndrome
Blood vessel related:
- Vascular disease (blood vessel disease, problems affecting the plumbing or the arteries, veins and capillaries)
- Angina chest pain when the heart muscle does not get enough oxygen
- Stroke (a type of cerebrovascular disease)
- Renal artery disease (plumbing that supplies the kidneys)
- Raynaud’s disease
- Peripheral vascular disease
- Blood clotting disorders.
THE PLAN: The risk factors we CAN change
CHOLESTEROL LEVELS hyperlipidemia, the inflammation in RA can affect our cholesterol levels and lipid ratio. This gives us a higher likelihood of developing Coronary Artery Disease; the narrowing of the blood vessels with plaque, leading to Angina, Shortness of Breath, and Heart Attack. Early monitoring and control of cholesterol levels is warranted! Let your family Dr. know this is required and that because you have RA your cholesterol levels have a higher chance of being abnormal and that you are at double the risk for heart disease.
HIGH BLOOD PRESSURE (hypertension) uncontrolled high blood pressure is a risk factor of CV disease that is controllable. It is called the silent killer because there are not often visible symptoms. You need to monitor your blood pressure readings and communicate them to your family Dr.
- Check your BP any time you are at the drug store and keep a record. If you are visiting the Dr’s office ask them to check it. Tell them why it’s important, you have RA and are at double the likelihood of CV disease.
- Even slight to moderate elevation in readings (if consistent) will add more pressure to the system and just like pressure in the plumbing of your house. It will shorten the lifespan of your pipes and appliances. You’ll blow your hot water tank! It adds stress to the heart, your vessels and all your organs. Know your readings and take steps with your Family Dr. to control your BP.
SLEEP APNEA If you snore, your significant other says they notice you pause or stop breathing (when you’re asleep) , or you gasp and wake yourself up sometimes; ask your Family Dr. for a sleep study. Untreated Sleep Apnea wrecks havoc on your heart. This is a simple fix, one of the first fixes a cardiologist would investigate if you were to visit their office. Treated sleep apnea can take this significant stressor off the heart. Sleep apnea is fairly common and has it’s own risk factors to be covered in a future blog.
LACK OF SLEEP “Sleep is essential for a healthy heart. People who don’t sleep enough are at higher risk for cardiovascular disease—regardless of age, weight, smoking and exercise habits. One study that examined data from 3,000 adults over the age of 45 found that those who slept fewer than six hours per night were about twice as likely to have a stroke or heart attack as people who slept six to eight hours per night.” Do you get your 8 hours? There are many aspects of RA that contribute to poor sleep. Will gaining tighter control of your disease improve your quality of sleep. Do you have any treatable sleep disorders? I never gave this aspect of RA much thought, but, improving my Restless legs, a syndrome that can accompany RA; made a huge impact! I saw a noticeable difference in my fatigue, energy levels and severity of flares.
SMOKING If you smoke there has never been a bigger reason to quit and I know personally this is no easy fix!
- Smoking damages the lining of your vessels which can cause angina, CV disease and stroke
- Reduces the amount of oxygen in your blood making the heart work harder
- Nicotine raises your blood pressure, increasing the pressure in the pipes
- you are more likely to develop blood clotting issues
- increases inflammation of RA
- smoking makes your RA harder to control, it contributes to more inflammation, which directly and indirectly increases your CV disease risk. Its a double whammy!
DIABETES all types of diabetes are treatable. Screening and identifying diabetes early on is important. It will lead to quicker control and less complications related to your cardiovascular system, therefore lessening your risk. Diet is a contributing factor in the development of pre-diabetes.
HEALTHY HEART NUTRITION your diet affects your risk directly as a”low-saturated fat, high-fibre, high plant food diet can substantially reduce the risk of developing heart disease” and indirectly by contributing to a few other identified risks such as obesity, your blood pressure and controlling diabetes. Sometimes it’s helpful to start by thinking of adding nutrition rather restricting certain foods . An easy first step is to integrate more fruits and vegetables, try aiming for 7-10 servings a day. Set small achievable goals.
OBESITY “If you have too much fat — especially around your waist — you’re at higher risk for health problems, including high blood pressure, high blood cholesterol and diabetes.” Having RA makes this a more difficult factor to control as being active isn’t necessarily easy or possible. Two free apps I have on my phone that make it a little easier for me to take action and monitor my activity/ weight are my pedometer and my fitnesspal.
PHYSICAL INACTIVITY is one of the most modifiable risk factors that can have a large impact on reducing your cardiovascular risk. But it is extremely hard when you suffer from overwhelming fatigue and constant pain to not live a more sedentary life. We all know that the complete absence of activity is not helpful. Find more information in this blog post that might help you cope. Any spot you can achieve on the continuum of activity is better than none. Don’t set yourself up for failure, aim your goals at improving the level you’re at (ie): not running an ultra marathon unless you’re a marathoner. Think of incorporating variation. Variation will help you maintain this lifestyle change and decrease your risk of injury related to your RA. Aerobic, strengthening and stretching exercises all lessen the inactivity risk. Any movement will improve your health. Make a short, measurable goal today, to be obtained in a defined period of time but, base it on your current level of activity. My goal: I am going to move for 10 minutes every day for the next 7 days. Identify what that movement will be for you. For myself that 10 minutes was a stretching video, but I stretched different body parts every day. Stretching the same body part for me would have lead to injury. No static stretching or holding the stretch, I only moved to the point just before the pain and then moved back away from it. Gentle movement to start. Being specific with your goal will help you achieve it.
ALCOHOL CONSUMPTION decrease it, regular use or high consumption of alcohol can hurt your heart and damage the heart muscle, leading to a higher incidence of cardiomyopathy (heart muscle disease). Alcohol affects the liver and some of our RA medications have this in common thus giving our liver a double hit!
STRESS ” it could be because chronic stress exposes your body to unhealthy, persistently elevated levels of stress hormones like adrenaline and cortisol. Studies also link stress to changes in the way blood clots, which increases the risk of heart attack.”
RA adds stress to our lives that truly, are already stressful. Be aware of the chaos and try to simplify your life, take a moment, breathe, go outdoors, play more, increase the frequency of the things you love to do, and if it appeals to you… meditate (if you follow my blog you will have seen me mention a resource I use the free app (my headspace). Strive for life balance.
MEDICATIONS research has shown that NSAIDS and STEROIDS can contribute to cardiovascular disease. This does not mean we should STOP them! There is a place for specific medications in the treatment of our disease. Please do not make alterations to your medication regime without consulting with your Rheumatologist.
I identify this risk here, to help you find the motivation to take control of your RA. You and your Dr. are a team and can work together to find the right balance for you. If there are modifiable factors that you can change, this may help you achieve better control of your RA. The risks associated with these medications are a very good reason to try … Perhaps, you would then lessen, your need for NSAIDS and STEROIDS.
BUT, sometimes it’s not possible. The positive effects these medications have on controlling your disease, inflammation, and improving your quality of life may lessen the increased risk associated with RA and cardiovascular disease in other ways. They may allow you to have fewer flares, less pain, more activity, less stress, lower blood pressure and tighter control of your disease…. Phew! Alot of stuff! Just by allowing you to live your life! A personal decision, to be made as a team with your physician. Again, it’s a balance.
The risk factors we CANNOT change:
FAMILY HISTORY increases your risk if a member of your family has cardiovascular disease
AGE increases your risk as we age
MENOPAUSE increases your risk as women lose the protective mechanism of estrogen
Having RA RA appears to represent an independent risk factor for cardiovascular disease. We cannot cure it, but we can do several things to achieve tighter control thus lessening our risk.