RA and Heart Attacks: 10 Ways to Protect Your Heart

If you have rheumatoid arthritis (RA), you also have double the risk for heart disease and heart attack.

This may be partly because body-wide inflammation affects the blood-vessel lining too, says Eric L. Matteson, MD, chair of rheumatology at the Mayo Clinic, in Rochester, Minn.

Certain RA drugs such as corticosteroids and NSAIDs may also up the risk of heart disease. But here are some things you can do to reduce your risk.

It’s best if you stick with heart-healthy food and consume the right amount of calories to avoid weight gain. "There’s no specific rheumatoid arthritis diet," says Guy Fiocco, MD, assistant professor of internal medicine at Texas A&M Health Science Center College of Medicine, in Temple.

One 2003 study conducted in Sweden found that a Mediterranean diet—high in fruits, vegetables, and healthy fats such as olive oil—lessened inflammation and seemed to promote better physical function in people with RA.

Following a Mediterranean diet may be a win-win, since this type of diet has been shown to be good for the heart too.

In addition to a balanced diet, you could take 1,000 milligrams of fish oil two or three times a day, says Dr. Matteson. “Not only does it have a small effect on reducing inflammation, but it also is good for managing blood fat.”

You can get this either in readily available supplements or by eating fish high in omega-3 polyunsaturated fats (try salmon) or nuts. Avoid

saturated fat, found in meat and high-fat dairy products, as it can actually increase inflammation.

Check with your doctor before taking supplements, especially if you're on medications like blood thinners. Keep in mind that fish oil may take several months to have an effect.

It's especially important to control other heart-disease risk factors if you have RA.

"This is something that should be watched more vigilantly," Dr. Fiocco says. That includes having your cholesterol under control—starting with diet but progressing to lipid-lowering drugs such as statins, if necessary.

A recent study suggested that heart-disease risk factors and guidelines for statin treatment may differ between RA patients and the general population. As for blood pressure, it should ideally be at or below 130/85, says Dr. Matteson.

Avoiding excess weight gain can help your heart and joints. "Maintaining a good weight and body composition through diet and exercise is very important," says Dr. Matteson.

This can be a challenge since some medications, such as corticosteroids, can cause weight gain, and exercise may be difficult if not impossible during flare-ups when fatigue and joint stiffness are at their worst.

Very active disease can actually change your metabolism and cause you to lose weight. But being very underweight with active arthritis also increases the risk of heart disease, Dr. Matteson says.

Smoking is bad news for anyone, but it's extra hazardous for people with RA. "Smoking seems to trigger immune system reactions and, in the long run, is associated with an increased risk for getting rheumatoid arthritis and having worse rheumatoid arthritis," says Dr. Matteson.

One recent study found that people with RA who smoked had more active disease than those who did not. Another found that smokers—especially heavier smokers—had an increased risk for developing RA in the first place.

There are few cardiologists who specialize exclusively in RA—perhaps none, says Dr. Matteson. But some are more knowledgeable about RA and its heart risks than others.

It can help to interview cardiologists before you choose one. Once you do commit, make sure you have a routine heart evaluation, which includes a stress test, Dr. Matteson says.

Your checkups might not need to occur more frequently than other people's, but they do need to happen, especially if you have other heart-disease risk factors, such as a family history.

It can be harder for people with rheumatoid arthritis to recognize a heart attack because they're less likely than the general population to experience typical heart-attack symptoms, and more likely to have so-called silent heart attacks.

Still, it is important to know the classic symptoms, which include pressure or pain in the chest or upper body, as well as shortness of breath, nausea, or light-headedness.

It’s even trickier in women because a heart attack may manifest as fatigue, an all-too-common RA symptom. “If there is new and unusual fatigue and the arthritis is well controlled, it could be related to something (other than the arthritis)," Dr. Matteson says.

Certain RA medications are worse than others when it comes to heart health. For example, corticosteroids fight inflammation but are also thought to promote hardening of the arteries. "Don’t rely on just steroids alone to control your arthritis," Dr. Matteson says.

In general, oral corticosteroids are recommended for relatively short-term use.

There are many other medications that treat RA, including DMARDs (disease-modifying antirheumatic drugs) such as Enbrel (etanercept) or methotrexate, which appear to reduce heart-disease risk, Dr. Matteson says.

When it comes to RA, this may be the number-one risk-reduction factor. “Getting your disease under control is really essential to reducing your risk,” Dr. Matteson says. “Drugs that get your inflammation under control actually do reduce the risk of heart disease in patients with rheumatoid arthritis.”

RA medications aren’t always easy or convenient to take, and most have well-known side effects. But knowing they protect your heart can be a motivating factor to stick with them.

Exercise can reduce heart-attack risk and "it can sometimes help to reduce the pain, keep bones stronger, and maintain muscle strength," says Dr. Fiocco.

But how do you exercise when you’re hurting? Aquatics are good and walking can often be a milder tonic, but even chair exercises can help, Dr. Fiocco says.

Check out the

Arthritis Foundation to find your local office, which can direct you to programs such as water exercises and tai chi.