People with Rheumatoid Arthritis Fare Worse After a Heart Attack

Following a heart attack, people with rheumatoid arthritis suffer greater heart-related complications, including an increased risk for dying, when compared to other heart attack patients, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in San Francisco, Calif.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

It is well known that patients with RA are at increased risk for heart attack; however, little is known about the risk of heart failure and death following heart attacks in these patients.

Researchers recently followed 38 heart attack patients who had RA to compare their mortality rates to those patients who had suffered a heart attack but did not have RA. Most patients were female, with a mean age of 76 years.

Patients with RA were hospitalized for their first heart attack between 1976 and 2001. Researchers evaluated treatment of heart attacks and tracked patient outcomes (heart failure and death). Diagnosis of heart attack and heart failure were validated using established epidemiological criteria, and rates of heart failure and death following heart attacks in the general population were based on previously published rates during the same years.

Of the 38 RA patients in the study, nine had experienced heart failure prior to the heart attack; of the remainder, a total of 18 RA patients developed heart failure following their heart attacks – making the risk of heart failure following a heart attack in patients with RA 45 percent higher than expected in the general population. The risk of death was noted to be 75 percent higher in heart attack patients with RA, and was particularly high among patients with rheumatoid arthritis who had a positive blood test for rheumatoid factor.

In all, researchers determined that patients with RA do suffer higher mortality and may be at higher risk of heart failure after a heart attack, but reasons for these outcomes are still unknown. The results of this study emphasize the need for better strategies for prevention, diagnosis and treatment of heart attacks in these patients.

“Heart disease can remain silent in those with rheumatoid arthritis, but the risk is there soon after the onset of the disease” explains Hilal Maradit Kremers, MD; Mayo Clinic epidemiologist and lead author of the study. “Regular cardiac checkups are important—as is lowering traditional cardiac risk factors, such as taking care of blood pressure and cholesterol and quitting smoking.”

The ACR is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with or at risk for arthritis and rheumatic and musculoskeletal diseases. For more information on the ACR’s annual meeting, see www.rheumatology.org/annual.