Increased Coronary Risk
- Autoimmune rheumatic diseases (AIRDs), including rheumatoid arthritis (RA), are associated with higher rates of cardiovascular morbidity and mortality.124
- Cardiovascular disease is the main cause of death among RA patients, primarily due to ischemic heart disease secondary to atherosclerosis.124
- RA is an independent risk factor for multi-vessel CAD.125
- Among patients with CAD, those with RA were significantly more likely to have multivessel disease than those without RA.125
- RA patients have a significantly higher prevalence of angina pectoris.126
- Women with RA are at increased risk of MI.127
- The risk of MI in women with RA is twice that of women without RA, even after adjusting for a variety of variables.
- Women who have had RA for  10 years are at >3 times the risk of MI compared with women without RA.
The most notable findings of increased CHD mortality in RA are among younger women, aged 15 to 49.128
How Does RA Increase Coronary Risk?
While the precise reasons for the increased coronary risk in patients with RA or other AIRDs have not been clearly identified, a number of factors have been implicated:
- Inflammatory components of the immune system124,125,127:
- CRP is elevated in RA125,127
- CD4+CD28- T cells are involved in the pathogenesis of both RA and atherosclerosis124,125
- Traditional risk factors124
- Reduced physical activity associated with RA127
- Corticosteroid use (although evidence is inconsistent)124,125,128
- Increased homocysteine levels128
- Hormonal factors128
Issues in CAD Screening
- AIRD patients should be treated as belonging to a high cardiovascular risk group and may be targets for early identification and preventive therapy for CAD.124
- AIRD patients have been shown to have advanced subclinical atherosclerosis, which may precede the appearance of clinical disease.124
- It may be prudent to consider aggressive cardiac preventive measures aimed at established CAD risk factors in RA patients.127
- Given the increased mortality at a younger age and the subclinical atherosclerosis noted in RA, earlier CAD screening may be warranted in RA patients compared with the general population.
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Diabetes
Obesity
Metabolic Syndrome
Race/Ethnicity
Defining Risk in Women
Exercise Capacity in Women
C-Reactive Protein
Atrial Fibrillation
Heart Failure
Fat Distribution and Heart Disease in Women
Fitness Levels
Rheumatoid Arthritis
Aging
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