Patients with inflammatory diseases like rheumatoid arthritis or systemic lupus erythematosus have an increased risk of suffering a heart attack, and that risk is even greater if they possess other risk factors—such as elevated lipid levels.
There is strong evidence suggesting inflammation plays a direct role in atherosclerosis. Inflammation is part of the cascade of events that unfolds in diseased arteries, triggering a response that ultimately leads to blockage of a vessel, which can result in a heart attack.
Autoimmune conditions such as rheumatoid arthritis and lupus are characterized by systemic inflammation in the joints and other tissues of the body. To investigate the impact of this systemic inflammation on the heart, a group of Swiss researchers studied patient profiles in the General Practice Research Database (GPRD). This is a registry of more than 3 million residents in the United Kingdom who were entered into the database through general practitioners.
The study was published in the January issue of The American Journal of Cardiology.
Performing what’s called a case-control study, the researchers selected nearly 8,700 cases—patients in the registry who had their first heart attack, and compared them to almost 34,000 controls—patients who had not had a previous heart attack. The researchers matched four control patients from the database for every one case patient based on age, gender, general practice attended, and number of years in the registry. Nearly 63% of the study participants were men.
They then compared the proportion of diagnosed rheumatoid arthritis or lupus as well as other risk factors for heart disease between patients and controls. Those risk factors included body mass index, smoking habits, aspirin use, non-steroidal anti-inflammatory drug use, and history of hypertension, high cholesterol, atherosclerosis, and diabetes.
The risk of developing a first-time heart attack was almost one and a half times greater for those with rheumatoid arthritis and more than two and a half times greater for those with lupus. The risk of having a heart attack was higher for women with rheumatoid arthritis than it was for men with the same condition. And the risk of a heart attack in men with lupus was higher than it was for women.
When patients had either lupus or rheumatoid arthritis in combination with elevated blood lipid levels—known as hyperlipidemia—the risk of having a first-time heart attack was even higher.
"These results," write the researchers, "fit well with the concept that systemic inflammation accelerates atherosclerosis and increases the risk for cardiovascular disease."
They suggest that patients with chronic inflammatory disease, such as lupus or rheumatoid arthritis, may benefit from aggressive strategies—such as medications, diet and exercise—to prevent a first time heart attack.