Resources for Patients

The Heart-Joint Connection

 

What does heart disease have to do with my arthritis?

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• People with inflammatory arthritis, such as rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, have up to a 50% higher risk of developing heart disease compared to people without inflammatory arthritis.

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• Inflammatory arthritis is associated with known risk factors for heart disease, including high blood pressure, diabetes and abnormal cholesterol levels.

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• The increased risk of developing heart disease is related in part to these known risk factors, but the severity of inflammation in the joints is also important.

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Why do people with inflammatory arthritis develop heart disease?

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• Atherosclerosis, the buildup of cholesterol within blood vessel walls (also known as plaques), is the process that leads to the majority of heart diseases.

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• Atherosclerosis leads to the narrowing of blood vessels, increased blood pressure and decreased blood flow to the heart and other organs. Some unstable plaques can rupture, triggering a clot that may cause a heart attack or stroke.

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• Uncontrolled inflammation, such as in active rheumatoid or psoriatic arthritis, leads to rapid progression of atherosclerosis and increases the risk of plaque rupture.

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How to know if you’re at Risk

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• Your age and sex as well as information about your blood pressure, blood sugar, cholesterol levels, and lifestyle habits help the physician to estimate your future risk of developing heart disease.

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• More advanced tests, like CT and ultrasound of the heart, can improve the accuracy of identifying people who are at high risk of developing heart disease.

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• The risk also depends on the severity of inflammation in the skin (for psoriatic arthritis) and joints.

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Cardio-Rheumatology Clinic at Women's College Hospital, Toronto, Canada

 

The Cardio-Rheum Clinic at Women's College Hospital runs once a week and accepts referrals of patients with rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis, aged 40 years and older, who do not have a history of cardiovascular disease. Patients undergo a comprehensive evaluation including a cardiologist assessment, laboratory testing, non-invasive stress testing where appropriate, calcium score coronary CT and carotid ultrasound to quantify the carotid plaque burden. Based on the results of this detailed assessment, patients are stratified according to their predicted future cardiovascular risk and recommendations are made regarding medication and lifestyle interventions required to reduce cardiovascular risk. The team plans to follow the clinic patients in a study to determine the long-term outcomes of these interventions and to inform the development of evidence-based guidelines. 

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