Arthritis inflammation increases cardiac death risk

Systemic inflammation increases the risk of dying from cardiovascular disease in patients with Rheumatoid Arthritis, a new study shows, even after factoring in the effects of traditional cardiovascular risk factors and other illnesses."

The rate of illness and death from cardiovascular disease is higher among rheumatoid arthritis patients, and there is increasing evidence that inflammation plays a key role in the development of atherosclerosis, also known as hardening of the arteries, Dr. Sherine E. Gabriel of the Mayo Clinic in Rochester, Minnesota, and colleagues report in the medical journal Arthritis and Rheumatism.

They therefore conducted a study to investigate if evidence of more severe inflammation in rheumatoid arthritis patients might be associated with an increased risk of death from cardiovascular disease.

Gabriel and colleagues looked at 603 patients with rheumatoid arthritis, representing all residents of Rochester 18 years or older who were diagnosed with rheumatoid arthritis between 1955 and 1995. Study subjects were followed for an average of 15 years.

The researchers found a number of factors and other illnesses increased the risk of cardiovascular death, including personal history of cardiovascular disease, high blood pressure, diabetes mellitus, cancer and history of Alcoholism.

After accounting for these factors, the researchers found that three markers of inflammation were independently associated with a greater risk of cardiovascular death.

These included having at least three high erythrocyte sedimentation rate tests; rheumatoid arthritis vasculitis; and rheumatoid lung disease. Swelling of large joints also was associated with a greater risk of cardiovascular death.

In addition, the researchers found that corticosteroid drug use increased the risk of cardiovascular death among rheumatoid arthritis patients who had no history of Heart disease, but reduced cardiovascular death risk among those who did have a history of heart disease.

While these drugs can promote high blood pressure and high cholesterol, the researchers note, their anti-inflammatory effects may benefit patients with existing heart disease.

The researchers suggest that new studies should investigate whether aggressive treatment to tightly control systemic inflammation in rheumatoid arthritis patients can reduce the risk of cardiovascular death - similar to the benefits of tightly controlling blood sugar levels in diabetics.

SOURCE: Arthritis and Rheumatism, March 2005.