Two factors come together to increase your risk: chronic inflammation and shared risk factors.
Inflammatory substances called cytokines stimulate joint destruction in RA and blood vessel damage in cardiovascular diseases (CVD). Inflammation causes plaque to build up in the arteries, which slowly narrows blood vessels and blocks blood flow, and is the leading cause of heart attacks and strokes.
The other reason people with rheumatoid arthritis (RA) are more likely to develop heart disease are shared risk factors like these:
Hypertension – Several factors increase blood pressure in people with RA, including lack of exercise and medications used to treat the disease (such as NSAIDs and steroids). People with RA also have less elastic arteries that can narrow, allowing less blood to pass through and increasing blood pressure.
Metabolic syndrome – Nearly 40% of people with RA have metabolic syndrome, compared to less than 20% of people overall. This set of symptoms, which include obesity, high triglycerides and cholesterol, high blood pressure, and high blood sugar levels, doubles the risk of CVD.
Obesity – Joint pain makes it difficult to exercise, and lack of physical activity can cause weight gain. Obesity is linked to CVD risk itself, as well as cardiovascular risk factors such as high blood pressure and high blood sugar. Fat cells release inflammatory substances that contribute to inflammation throughout the body and the risk of CVD.
Smoke People with RA are more likely to smoke than those without the disease. Not only has this habit been linked to more aggressive joint destruction, but smoking also accelerates blood vessel damage and contributes to narrowing of the arteries. Smokers with RA have a 50% higher risk of cardiovascular events than non-smokers with RA.
Abnormal lipids – RA has an unusual effect on lipids, or fats, in the blood. Experts call it the “lipid paradox.” People with RA have high levels of triglycerides, low levels of low-density lipoproteins (LDL, or “bad” cholesterol), and low levels of high-density lipoproteins (HDL, or “good” cholesterol). Although low LDL is good for the heart, low HDL cholesterol and high triglycerides contribute to cardiovascular disease.
