Rheumatoid arthritis is most commonly associated with joint pain and destruction that can be severe, and even crippling, if the disease is not properly treated or if response to treatment is poor. The damage caused by RA is not confined to the joints, however. RA is a chronic autoimmune disorder that occurs when the body’s immune system begins to attack its own healthy tissue.
As part of this process, the body produces a number of proteins, called cytokines, that cause inflammation throughout the body, targeting multiple organ systems, including the heart and blood vessels. As a result, people with rheumatoid arthritis have an increased risk of developing cardiovascular disease — the No. 1 killer of Americans — compared with the general public.
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“RA patients have higher rates of heart attacks, strokes, sudden cardiac death and heart failure compared with otherwise similar people without RA,” says Dr. Jon Giles, a rheumatologist in New York and an associate professor of medicine in the Division of Rheumatology at the College of Physicians and Surgeons at Columbia University. “Just like in the general population, not everyone with RA will have clinical heart disease,” Giles says. “However, they are more prone to [getting] heart disease.”
Physicians recommend that people with RA follow the normal precautions to lower this risk. These include eating a healthy diet that is low in saturated fats and sugar, exercising, quitting smoking and losing weight. Another strategy that may be especially beneficial is the use of medications known as statins.
According to the Mayo Clinic, statins are drugs that block the production of cholesterol. They may also help the body resorb cholesterol that has already accumulated on blood vessel walls in the form of plaques. When these plaques build up enough to restrict or block blood flow in the heart and brain, heart attacks and strokes can result. Likewise, if plaques break off and enter the bloodstream, they can lodge in the blood vessels of the brain or lungs, causing a stroke or pulmonary embolism.
Statins were introduced in the late 1980s after research showed that they reduce the incidence of a repeat heart attack in people who have already suffered one or more such events. In 2016, the U.S. Preventive Services Task Force recommended that statins be prescribed as a means of preventing a first heart attack or stroke in people with at least one risk factor for cardiovascular disease, including diabetes, high cholesterol and current smoking.
A 2016 study also showed that people with RA can benefit from statin therapy. The researchers found that statins reduced the rate of death for any reason — all-cause mortality — by 21 percent in RA patients compared with similar patients who were not taking statins.
So, if you have RA, should you be taking statins to reduce your risk of cardiovascular disease?
Primary care providers and rheumatologists “are becoming more comfortable prescribing statin therapy directly especially as the association between inflammatory autoimmune disease and cardiovascular disease becomes more and more clear,” says Dr. Shariq Chudhri, clinical assistant professor in the Division of Rheumatology at the University of Arizona College of Medicine in Tucson.
However, Chudhri cautions that more research is necessary before he is willing to prescribe statins to every patient with RA. “At this time, evidence is insufficient to recommend starting statin therapy in patients whose only cardiovascular risk factor is the presence of RA,” he says.
Dr. Shailendra Singh, the rheumatology medical director at the White River Medical Center in Batesville, Arkansas, agrees. “We do not have enough evidence yet to determine if statins are beneficial in [every RA patient, such as] young patients who have new-onset RA and no other risk factors for cardiovascular disease.”
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“[We do know that] statins reduce the risk of cardiovascular disease in patients with RA who have other risk factors like obesity, diabetes, hypertension, high cholesterol and smoking,” Singh says. “They also reduce the risk in patients who are 50 years or older and have had RA for more than 10 years [but who do not have] other risk factors for cardiovascular disease.”
“I am more likely to start statin therapy in [RA] patients with other cardiovascular risk factors,” Chudhri says.
However, he cautions that statin therapy alone is not enough to ensure optimum risk reduction in people with RA and a history of heart disease.
“In patients with known cardiovascular disease, it is critical to collaborate with a cardiologist in managing a risk reduction strategy for these patients, beyond statin therapy alone,” he says. “We do not hesitate to refer [these] patients to a cardiologist for further evaluation and assistance, if needed,” he adds.
Dr. Eric Matteson, professor of medicine in the Division of Rheumatology at the Mayo Clinic in Rochester, Minnesota, concurs with this approach.
“At Mayo Clinic, we routinely assess our [RA] patients for cardiovascular disease risk in our Cardio-Rheumatology Clinic, a clinic in which cardiologists and rheumatologists work together,” he says. “We individualize the treatment approach according to [the patient’s] past history and a comprehensive assessment of [his or her] cardiovascular risk factors.”
“Studies at Mayo have found that the risk of heart disease has been declining in recent years with improved control of RA,” Matteson explains. “It is our view that it is very important that active RA be brought under control to further reduce cardiovascular risk, as persistent and active disease is a risk for cardiovascular disease.”
[See: How to Practice Yoga When You Have Arthritis or Another Chronic Condition.]
“I routinely prescribe statins to persons [with RA] who have [cholesterol levels] that are known to increase the risk of coronary artery disease,” Matteson says, “but I do not routinely prescribe them to every patient with RA.”
Many different statins are currently available, and the choice of statin is tailored to the patient, depending on specific factors, such as other medications the patient may be taking. “For example, some statins can affect levels of blood thinners, such as Coumadin,” Chudhri says.
So, what is the bottom line?
“Patients with RA and a history of cardiovascular disease should be on statins if they can tolerate them,” Singh says.
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Statins Can Help Lower the Risk of Cardiovascular Disease in Patients With Rheumatoid Arthritis originally appeared on usnews.com
