If you have RA, you're at increased risk of hardening of the arteries, heart attack, and other cardiovascular issues, and research suggests that inflammation may be partly to blame.

The bad news: If you have rheumatoid arthritis (RA), you have a greater risk of dying from heart disease. Fatal heart attacks and another common cardiovascular condition — stroke — are the causes of many premature deaths in people with RA. Add other risk factors for heart disease, such as high cholesterol or diabetes, and the chance you'll have a heart attack or stroke is even greater.

The good news: There's a lot you can do to control your heart disease risk when you have rheumatoid arthritis.

What's Behind the RA-Heart Disease Link?

So why does RA lead to more heart problems? Recent research found that people with rheumatoid arthritis may experience faster rates of hardening of the arteries, or atherosclerosis. A team led by rheumatologist Jon T. Giles, MD, MPH, looked at the progression of atherosclerosis in 158 RA patients who had never had a cardiovascular event, such as a heart attack or stroke. They found thickening of the arteries in most patients. Patients treated with a class of medications called TNF inhibitors had a slower rate of atherosclerosis progression, as did those taking cholesterol-lowering medications (statins). According to Dr. Giles, who is an assistant professor of medicine at Columbia University in New York City, higher exposure to prednisone in the past was associated with a faster rate of progression.

The data showed that higher levels of inflammation may predispose RA patients to a greater risk of atherosclerosis and cardiovascular events, says Giles. Also, people with severe symptoms of rheumatoid arthritis (more swollen joints, for example) had greater build-up of plaque in the arteries.

Despite the data pointing to a correlation between RA and heart disease risk, experts are still unsure of the exact mechanism underlying it. The nature of rheumatoid arthritis itself may contribute to the higher heart disease and heart attack risk.

"Increasingly, we think that chronic inflammation due to RA causes changes in the lining of blood vessels, making it more likely that cholesterol will deposit in the vessel wall," explains Victoria Shanmugam, MD, a rheumatologist at Georgetown University Hospital in Washington, D.C. "There is also evidence that, for patients with higher levels of inflammation and RA disease activity, cholesterol deposits are more likely to be unstable, leading to increased risk of heart attack."

There is still a lot to understand about the relationship between rheumatoid arthritis and heart disease. Some researchers theorize that the molecules that cause RA (such as cytokines) also contribute to blood vessel damage, but this relationship has not been fully defined.

According to the researchers, the common link between rheumatoid arthritis and heart disease may be inflammation. People with RA often have higher levels of markers of inflammation in their blood, such as C-reactive proteins, which the body produces in response to tumor necrosis factor (TNF). Heart disease has been linked to higher levels of these markers as well.

5 Ways to Lower Your Heart Disease Risk

If you have rheumatoid arthritis and want to reduce your risk of heart problems, here are some ways to swing the balance in your favor:

• Know your heart disease risk. Heart disease is a leading killer, with or without rheumatoid arthritis. If you have RA and heart disease risk factors, such as a family history of heart disease, high cholesterol, high blood pressure, overweight or obesity, or diabetes, work with your doctor to get them under control.
• Practice heart-healthy living. Eat a healthy, balanced diet and try to get daily exercise. Exercise is also good for your RA, although you might need to check with a physical therapist to make sure you are choosing the best activities. Medications that help control heart disease risk factors, such as cholesterol, are just as effective for people with RA as their peers.
• Don't ignore heart disease symptoms. People with RA can become so focused on their rheumatoid arthritis symptoms that they may ignore other problematic signs, such as always being short of breath.
• Control rheumatoid arthritis. Out-of-control rheumatoid arthritis symptoms can keep you from following a healthy lifestyle — getting the exercise you need, eating healthfully, and maintaining a healthy weight. Work with your doctor to get RA under control.
• Make wise medication choices. New drugs frequently become available. Because there is a small link between steroids and heart disease risk, it's a good idea to use other classes of medication to control rheumatoid arthritis symptoms if you can. On the other hand, Giles' research suggests that some RA medications, such as those that control TNF factors, also help reduce heart disease risk.

If you have RA, the news that your heart disease risk is elevated may just add more stress. But you can use that knowledge to propel you toward making better overall health choices. Work with your medical team to choose the best course for you.