Cardiovascular Disease is a Serious and Life-Threatening Arthritis Complication
It usually strikes before age 60 and most often in the first year after diagnosis when inflammation is highest. The thought of having a heart attack at age 40 or 50 is not top of mind for most because, in the general population, cardiovascular disease is more common after age 60. Yet, heart attacks, strokes and blood clots in the legs and lungs are the leading cause of death in arthritis patients. Through research, our scientists are determining the risk factors in different types of arthritis and finding ways to prevent this complication.
Below are some of the more frequently asked questions, related research articles, videos, and general information that may be helpful in understanding the connection between cardiovascular disease and arthritis. We hope that building public awareness and knowledge about this less-known arthritis complication will encourage people to take steps to improve their health and reduce their risk.
Frequently Asked Questions
How do I know if my medications increase or decrease my risk of cardiovascular disease?
Ask your doctor or pharmacist. Be proactive and take your health into your own hands. It’s important to understand that the risk of cardiovascular disease associated with some medications may be rare and sometimes uncontrolled inflammation is the most important risk factor.
What member of my care team should I talk to about my risk of cardiovascular disease?
You should speak to your primary care doctor and rheumatologist, but you should also be proactive and make shared decisions that take into consideration both benefits and risks.
As someone who has been recently diagnosed with arthritis, do I need to worry about my risk of cardiovascular disease?
Yes, our research shows that the highest risk of cardiovascular disease (including heart attacks, strokes and blood clots in the legs and lungs) is within the first year after diagnosis when inflammation is at its peak.
Does the risk of cardiovascular disease differ by type of arthritis?
Yes, risk is higher for diseases with a more systemic and prolonged inflammation (e.g. lupus).
If I'm at high risk to develop cardiovascular disease, how much of this risk is related to my arthritis versus my medications?
It is always a combination of both. It’s important to tackle inflammation first and then avoid prolonged use or high doses of medications with an increased risk of cardiovascular disease (e.g. prednisone).
What is the connection between inflammation and risk of cardiovascular disease?
Systemic inflammation increases the risk of damaging the wall of the heart arteries, which facilitates atherosclerosis – a condition where plaque builds up inside the arteries. Moreover, systemic and uncontrolled inflammation promotes blood clots (heat, brain, legs, lungs) by decreasing the natural anticoagulants (which hinder the clotting of blood) that our body produces.
Are there changes that I can make to my lifestyle to lower my risk of developing cardiovascular disease?
Yes, control your weight. If you smoke, quit. Do moderate physical activity for 30-40 minutes, four times per week. Eat a healthy diet (vegetables, proteins and low carbs). Then, take your medications to control inflammation and prevent complications.
Is my risk of having a cardiovascular event heightened when I’m having a flare?
Yes, remember that inflammation = promotion of blood clotting.
I’m not taking any medications to manage my arthritis. What is my risk of cardiovascular disease?
That depends on the type of arthritis you have and your disease activity. However, the risk can go from 50 per cent to 400 per cent when compared to people from the general population who do not have arthritis.
Why is prednisone associated with an increased risk of cardiovascular disease?
Prednisone promotes diabetes, elevates cholesterol, and increases blood pressure. It, therefore, promotes accelerated atherosclerosis – plaque build-up in the arteries. If you need to be on prednisone, then talk your doctor to find out the lowest dose and the shortest duration that you need it. Prednisone is never the only treatment for arthritis.
How have advancements in arthritis treatment changed the risk for cardiovascular disease associated with arthritis or arthritis medications?
Some old medications such as Plaquenil (hydroxychloroquine or methotrexate) have been shown to decrease the risk of cardiovascular disease. Some new therapies (e.g. biologics) have also been shown to decrease cardiovascular disease risk. By controlling inflammation, we are preventing CVD complications. Following your treatment plan is very important.
Does the risk of cardiovascular disease differ based on the year/era that someone was diagnosed with arthritis?
Yes, our research has shown that the risk of cardiovascular disease has reduced in recent years likely because patients and doctors are more aware of this risk and are taking the necessary steps to prevent complications by treating inflammation more aggressively.
Shall I stop my medications once my arthritis in controlled?
Usually not, the inflammation gets controlled with medications (disease modifying, anti-rheumatic drugs also known as DMARDs) and therefore, when you stop them, the inflammation will come back. However, for prednisone yes, it is recommended to use it for a short time and at the lowest possible dose. Talk to your rheumatologist about this.
Why is there no cure for arthritis yet?
There isn’t a cure for arthritis because we still do not know the cause. We are getting there – that’s why we have new treatments.
Are there regular tests that you should get your doctor to do for preventative purposes or to check your heart health?
Tests should be ordered with a purpose rather than to see what is abnormal.
Do you have any information on CBD and THC as alternatives to Ibuprofen, etc.?
New research suggest that CBD helps for sleep and pain. THC is not recommended. But most “oils” have both CBD and THC (the ratio should be 1:10).
Regarding inflammation, how much can we rely on a low C-Reactive Protein (CRP) level?
You can often rely on a low CRP level. But there are some patients who will have active disease and normal CRP. Keep in mind that CRP is not specific and other conditions (e.g. infection, weight, etc.) can also elevate CRP. Clinical exams in combination with labs and symptoms reported by the patient are most important.
Do blood clots in legs manifest as intense leg cramps that resolve when standing on leg?
No, it is usually pain, redness and swelling.
If rheumatoid arthritis medications indicate a risk of increased blood pressure, high cholesterol, etc., do they further increase risk of cardiovascular disease as well?
Yes, prednisone is the usual one. Other medications are safe.
Are nonsteroidal anti-inflammatory drugs (NSAIDs) bad to take long-term?
Yes, we do not recommend NSAIDs as first-line therapy, but they can be taken long term if they help and favourably impact quality of life. But close monitoring is needed. Risks and benefits need to be weighed by the patient and doctor.
What would the cardiovascular disease risk factor be for someone living with rheumatoid arthritis most of their life?
If the disease has been under good control and the patient has no other risk factors for cardiovascular disease, then the risk is close to that of the general population.
Where does osteoarthritis fit into all this?
Osteoarthritis has also been associated with increased risk of cardiovascular disease, but to a lesser extent than other truly inflammatory types of arthritis.
Is Naproxen ok?
Naproxen has a safer profile for cardiovascular disease.
Some rheumatoid arthritis patients over age 70 may have thickening of the carotid arteries. Should patients be tested yearly?
Yes, for people with thickening of the carotid arteries by cholesterol, this is an indirect way to screen for atherosclerosis and risk of stroke or heart attacks. It is done by ultrasound and is not an invasive test. Highly recommended if for patients with a family history of stroke or heart disease – especially if occurred before age 60.
Are there clinical guidelines about cardiovascular disease and arthritis that can be shared with family doctors?
Yes, screen for cardiovascular disease like they do for diabetes as the risk of cardiovascular disease is similar between the two diseases.
Is research on cardiovascular disease and arthritis driven by big PHARMA?
No, PHARMA develops new therapies using knowledge obtained via research. Not all research is done by big PHARMA. In fact, most of the research is done independently.
Do individuals diagnosed a long time ago and after years on NSAIDS and aspirin have an increased risk of cardiovascular disease?
If you haven’t developed cardiovascular disease by now and your disease is under control, your risk is low. Remember, our data suggests that the highest risk is early on in a person’s disease.
My mother died at the age of 49 from a heart attack. Do you think her rheumatoid arthritis caused it?
It is hard to know. But it is possible that she may have had hereditary disorders of lipids or other diseases that provoke early heart attacks.
How long can a person with osteoarthritis take Tylenol?
Tylenol can be taken for life. It is very safe but the dose has to be right: 1 gram x 3 /day.
Do NSAIDs help with osteoarthritis? Is there inflammation associated with osteoarthritis?
Yes, but the inflammation in osteoarthritis is less than in rheumatoid arthritis.
Do you have any data on use of medical cannabis to reduce risk of cardiovascular disease?
I am not aware of good research assessing this question. However, theoretically, it will be unlikely as there is no evidence to my knowledge that cannabis works on inflammation.
Are there any less risky NSAIDs?
Yes, Naproxen and Aspirin can actually be protective. However, they still increase the risk of kidney toxicity if taken for prolonged periods of time.
If you have inflammatory arthritis and get COVID-19, do you have a higher risk of developing blood clots?
Yes, because you would have two inflammatory conditions at once.
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