Rheumatoid arthritis and cardiovascular complications – A noteworthy correlation

14/05/2024

Cardiovascular complications are one of the main problems that patients with rheumatoid arthritis suffer. Specifically, rheumatoid arthritis can increase the risk of cardiovascular diseases such as myocardial infarction, stroke and atherosclerosis due to the accumulation of fat, cholesterol and plaque on blood vessel walls by two times.

The relationship between rheumatoid arthritis and cardiovascular disease (Photo: Freepik)

Why do patients with rheumatoid arthritis have high cardiovascular risk?

Rheumatoid arthritis is an extremely common disease in Vietnam, especially among the elderly. Rheumatoid Arthritis is an autoimmune disease that causes swelling, pain, and stiffness in the joints, causing difficulty in movement. Additionally, rheumatoid arthritis is a chronic inflammatory disorder that can affect more than just your joints. The leading complication that patients encounter when suffering from rheumatoid arthritis is cardiovascular disease complications. Rheumatoid arthritis increases the risk of cardiovascular diseases such as heart attack, stroke and atherosclerosis (the buildup of fat, cholesterol and plaque on blood vessel walls). There are many studies showing that rheumatoid arthritis patients have a higher risk of cardiovascular disease than normal people.

Many studies have shown that patients with rheumatoid arthritis have a higher risk of cardiovascular disease than normal people (Photo: Freepik)

According to a 2011 study in the journal Nature Reviews Rheumatology, more than half of rheumatoid arthritis patients prematurely died of cardiovascular disease.

Patients with rheumatoid arthritis are 1.5 times more likely to develop coronary artery disease (CAD) than the general population.

In a 2015 study with the topic “An Overview of the Nature of Rheumatism”, British investigators found that rheumatoid arthritis patients have a higher risk of atherosclerosis than the general population and its progression is at a faster speed. Atherosclerosis begins early in the course of rheumatoid arthritis – often before joint symptoms develop and progresses rapidly after a patient is diagnosed with rheumatoid arthritis

A 2012 Mayo Clinic study also found that inflammation also affects the veins, with the risk of deep vein thrombosis three times higher in people with rheumatoid arthritis. Patients with rheumatoid arthritis are 5 times more likely to have Atrial Fibrillation (AF – Heart arrhythmia that can increase the risk of stroke) than normal people. Compared with people without rheumatoid arthritis, patients with rheumatoid arthritis are also twice as likely to develop congestive heart failure. Pericarditis is also commonly seen in patients with rheumatoid arthritis. When the two layers of inflamed membrane rub against each other, the patient has severe, sharp chest pain.

The cause of rheumatoid arthritis increases the risk of cardiovascular diseases?

Main causes of rheumatoid arthritis that increase the risk of cardiovascular diseases (Photo: Freepik)

“Inflammation, no matter where it comes from, is a risk factor for heart disease,” says rheumatologist Jon T. Giles. So it’s not surprising that people with rheumatoid arthritis experience more cardiovascular events.

– In rheumatoid arthritis, inflammation causes damage to the lining of blood vessels. In addition, with an excess of proinflammatory cytokines, excess muscle plaques accumulate. This fatty plaque narrows the arteries, increases blood pressure, and reduces blood flow to the heart and other organs. Konstantinos Loupasakis, a rheumatologist at MedStar Washington Hospital Center, also pointed out: “Inflammation appears to be at the core of the link between some types of arthritis and heart disease. When inflammation is high, fat accumulates more quickly on artery walls, restricting blood flow and contributing to cardiovascular problems’’.

– As rheumatoid arthritis is an autoimmune disease, its autoimmune disorders contribute to increased endothelial dysfunction, oxidative stress, and activation and migration of leukocytes in the vascular bed. The adhesion of leukocytes to the vascular endothelium is a consequence of the inflammatory process that causes atherosclerosis.

– Systemic inflammation along with rheumatoid arthritis, combined with lifestyle-related cardiovascular risk factors such as physical inactivity, obesity, etc., can contribute to cardiovascular diseases in rheumatoid arthritis.

– In addition, according to Martha Gulati, a cardiologist in Phoenix, Arizona, some arthritis medications can also contribute to the risk of heart disease. Corticosteroids such as prednisone – commonly used to ease attacks of arthritis – can increase cholesterol and make insulin less sensitive. Both contribute to cardiovascular risk. That’s partly why rheumatologists try not to give patients long-term steroids. Furthermore, using OTC nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen for pain may increase the risk of cardiovascular problems such as blood clots and heart failure, according to a 2015 analysis by the FDA.

Factors put people with rheumatoid arthritis at increased risk of cardiovascular complications and stroke

Rheumatoid arthritis is a chronic disorder of the immune system. To date, scientists have not yet found the exact cause of this disease. Therefore, doctors often rely on risk factors and the pathogenesis of the disease to treat rheumatoid arthritis.

– Hypertension: There are many factors that can affect blood pressure in patients with rheumatoid arthritis, including inflammation, physical inactivity, and medication use.

– Obesity: Obesity contributes to cardiovascular events in patients with rheumatoid arthritis. However, assessing obesity in patients with rheumatoid arthritis can be difficult as BMI does not accurately reflect the ratio of adipose tissue to muscle. Meanwhile, patients with rheumatoid arthritis may experience reduced muscle mass and excess fat accumulation.

Smoking: Smoking increases the severity of the disease and poor response to treatment. All affect the incidence of cardiovascular disease in people with rheumatoid arthritis.

– Dyslipidemia: Dyslipidemia is often seen in patients with rheumatoid arthritis and is also associated with an increased risk of cardiovascular disease. The concentration of lipids (triglyceride, bad LDL cholesterol, good HDL cholesterol) in people with rheumatoid arthritis is often more complicated than in people without this disease due to the interaction between cholesterol and inflammation.

Nutrition prevents cardiovascular complications for people with osteoarthritis

Therefore, to avoid overuse of anti-inflammatory drugs in treating the disease, experts also recommend that rheumatoid arthritis patients, in addition to using drugs, should have an appropriate nutritional diets with appropriate measures as follows:

Proper nutrition helps prevent cardiovascular disease for people with bone and joint diseases 

Keep your weight stable with an appropriate diet and moderate exercise to have a healthy body, supple health and a strong skeletal system.

– In addition to medication, rheumatoid arthritis patients can reduce pain by supplementing with antioxidants and fiber. Antioxidants such as Vitamin A, C, E, Selenium are found in many foods such as green vegetables, eggs, salmon,… have effective anti-inflammatory effects and prevent metabolic disorders. , strengthens the immune system, contributes to building a healthy body. Adding fiber to increase the growth of beneficial bacteria also has a clear effect of reducing inflammation.

– Patients with rheumatoid arthritis also need to supplement Vitamin K2 and unsaturated fats. Vitamin K2 helps prevent calcification of vessel walls, reducing the risk of atherosclerosis. Supplementing unsaturated fats such as MUFA and PUFA helps reduce the risk of cardiovascular diseases to have a healthy heart.

Correct and adequate nutritional intervention will help reduce inflammation and help prevent cardiovascular complications for people with rheumatoid arthritis. Currently, nutritional scientists at the Nutricare Medical Nutrition Institute – USA (NMNI-USA) and Nutricare have researched and launched the Nutricare Bone product. The product contains Glucosamine from the US, which plays a role in supporting the growth of joint fluid and cartilage cells to help lubricate joint cartilage, increasing the toughness and flexibility of joints. In addition, Nutricare Bone also provides Calcium with an exceptionally high content of 1,800 mg; Vitamin D3 increases Calcium absorption in the intestines and Vitamin K2 helps transport and increase the density of Calcium attached to the skeleton, maximizing the body’s efficiency in using Calcium, supporting strong bones; Unsaturated fats MUFA and PUFA help reduce the risk of cardiovascular diseases. On the other hand, 50 essential nutrients including plant protein and Whey protein from the US in Nutricare Bone help strengthen muscle mass for adults. With a low-sweet, low-fat formula, Nutricare Bone also helps support weight control.

It can be seen that rheumatoid arthritis greatly affects cardiovascular problems through many different mechanisms. Inflammation and the impact of the immune system can cause damage to blood vessels and increase the risk of stroke. Therefore, awareness and effective management of nutrition is the key to protecting overall health and improving the quality of life of patients.

References:

1. Nguyễn Thị Ngọc Lan, Bệnh học cơ xương khớp nội khoa, Nhà xuất bản giáo dục Việt Nam, 2009.

2. https://www.mayoclinic.org/diseases-conditions/rheumatoid-arthritis/symptoms-causes/syc- 20353648/

3. https://creakyjoints.org/living-with-arthritis/heart-health-inflammatory-arthritis/

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3890244/

5. https://pubmed.ncbi.nlm.nih.gov/15692992/

6. https://www.arthritis.org/health-wellness/about-arthritis/related-conditions/other-diseases/arthritis-and -heart-disease/

7. https://creakyjoints.org/living-with-arthritis/heart-health-inflammatory-arthritis/

8. https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-communication-fda- strengthens-warning-non-aspirin-nonsteroidal-anti-inflammatory

 

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