Mayo Clinic Finds Rheumatoid Arthritis Patients At Higher Risk For Unrecognized Heart Disease And Cardiac Sudden Death

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Mayo Clinic

Date:

2005-02-09

Mayo Clinic Finds Rheumatoid Arthritis Patients At Higher Risk For

Unrecognized Heart Disease And Cardiac Sudden Death

ROCHESTER, Minn. -- People with rheumatoid arthritis not only have a higher

risk of coronary heart disease than those in the general population, but

they have more silent, unrecognized heart attacks and sudden cardiac deaths,

according to a Mayo Clinic study published in the February issue of

Arthritis & Rheumatism (http://www.rheumatology.org/publications/ar). They

are also much less likely to complain of chest pain.

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Related section:

Health & Medicine

The increased heart disease risk may be present even before the diagnosis of

rheumatoid arthritis, according to the researchers. During the two years

before diagnosis of rheumatoid arthritis, patients with this disease were

three times more likely to have been hospitalized for an acute heart attack

and five times more likely to have an unrecognized heart attack. They were

also less likely to have had a history of chest pain, compared to those

without rheumatoid arthritis. After their diagnosis, the rheumatoid

arthritis patients were twice as likely to experience unrecognized heart

attacks and sudden cardiac deaths.

Hilal Maradit Kremers, M.D., lead study investigator and research associate

in the Mayo Clinic Department of Health Sciences Research, says the study

suggests three major messages for rheumatoid arthritis patients:

* The risk of heart attack is already there at the time a rheumatoid

arthritis diagnosis is first made.

* Heart disease can remain silent in those with rheumatoid arthritis.

Regular cardiac checkups are important, as is lowering traditional cardiac

risk factors, such as taking care of blood pressure and cholesterol and

quitting smoking.

* Heart disease in rheumatoid arthritis patients can manifest for the first

time as a cardiac sudden death.

The researchers were surprised to find that the increased cardiac events in

rheumatoid arthritis patients could not be explained by an increase in

traditional heart disease risk factors such as elevated cholesterol, blood

pressure and body mass index, diabetes, and alcohol abuse, indicates Dr.

Maradit Kremers.

" What we are finding is that though traditional cardiovascular risk factors

are important, they are less important for those with rheumatoid arthritis, "

says Dr. Maradit Kremers. " Something else is going on. It could be that

rheumatoid arthritis and heart disease have a common origin. What we do know

is that the cause cannot be explained by just one factor. It is

multifactorial. "

To date, there also is no definitive information for rheumatoid arthritis

patients about steps they can take to avoid heart disease, according to the

Mayo Clinic researchers. Meanwhile, they indicate that it is critical that

rheumatoid arthritis patients recognize their risks for heart disease and

that they seek medical care for any cardiac symptoms or complaints.

Dr. Maradit Kremers explains that the silent heart attacks found in the

study usually were detected when the rheumatoid arthritis patient saw a

physician for some other reason and an electrocardiogram was ordered,

revealing a past heart attack. " It's possible that people suffering from

rheumatoid arthritis have so much pain in their joints and are receiving so

many painkillers that they either don't feel the chest pain in the same way

as those without rheumatoid arthritis or don't appreciate its importance, "

she says.

Previous research has shown rheumatoid arthritis patients have a higher risk

of early death than others and that these deaths are mostly due to

cardiovascular disease. The Mayo Clinic research team conducted this study

to discover exactly why.

" We suspect that the systemic inflammation that characterizes rheumatoid

arthritis also promotes cardiovascular disease and cardiovascular death, "

says Sherine , M.D., the study's senior author and Mayo Clinic

rheumatologist, epidemiologist and chair of the Department of Health

Sciences Research. " And the goal of our research is to disentangle the

complex relationships between these two diseases. "

For this study, Mayo Clinic researchers studied a group of 603 Rochester

residents diagnosed with rheumatoid arthritis between Jan. 1, 1955 and Jan.

1, 1995 and compared them with 603 Rochester residents of the same ages and

gender without rheumatoid arthritis. Both the patients and the comparison

subjects were followed up for a median of 26 years before rheumatoid

arthritis diagnosis and 15 years after diagnosis. The researchers collected

detailed information about all study subjects' cardiac events and their

traditional cardiovascular risk factors: diabetes, blood pressure,

cholesterol, body mass index and smoking.

The paper detailing these findings is entitled " Increased Unrecognized

Coronary Heart Disease and Sudden Deaths in Rheumatoid Arthritis: A

Population-Based Cohort Study. "

To obtain the latest news releases from Mayo Clinic, go to

http://www.mayoclinic.org/news. MayoClinic.com (http://www.mayoclinic.com)

is available as a resource for your health stories.

http://www.sciencedaily.com/releases/2005/02/050204121639.htm