Heart Disease: Major Risk Factor for Many Rheumatology Patients

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Rheumatic diseases, such as rheuma­toid arthritis (RA), systemic lupus erythematosus (SLE) and vasculitis, can affect the body in many ways, but perhaps the most serious is the increased risk of heart disease for many patients.

As the risk of atherosclerosis in autoimmune disease patients gains increased attention, rheumatologists and cardiologists are collaborating more often to refer patients to each other and, at some institutions, see patients in a combined clinic.

The ultimate goal is to decrease inflammation to control rheumatic disease and lower the risk for heart disease, says cardiologist Donna Denier, MD, Franklin Square, N.Y. “When you see a reduction in inflammation, you see a reduction in cardiac mortality as well,” she says.

The Challenges

Although rheumatologists focus on the joints, it’s only natural to evaluate the patient as a whole person with preexisting conditions or risk factors that could be caused by rheumatic disease, says rheumatologist Orrin Troum, MD, Providence Saint John’s Health Center, Santa Monica, Calif.

Of course, patients with a disease such as RA who are also at increased risk for cardiovascular disease can’t be cured overnight. These patients bring a number of challenges, in addition to the usual challenges of treating inflammatory disease.

“One major challenge includes awareness of the increased risk and initiating the conversation with the patient about the need for risk assessment and management,” says Eric Matteson, MD, rheumatology chair at Mayo Clinic, Rochester, Minn.

Patients with RA or related diseases may not even know they are at greater risk for cardiovascular disease, but the risk is almost equal to the increased risk that diabetic patients have, Dr. Denier says. Additionally, cardiovascular signs may appear at an earlier age in these patients than in a normal patient population.

Another challenge is evaluating a patient’s medications that could further increase the risk for heart disease. For example, rheumatologists often prescribe steroids, which do not interact well with the aspirin or anti-platelet drugs a cardiologist might prescribe, Dr. Denier says.

Additionally, certain drugs used to treat RA, such as prednisone, can increase risks to the heart, says rheumatologist M. Elaine Husni, MD, MPH, director, Arthritis & Musculoskeletal Treatment Center, Cleveland Clinic, Cleveland.

Some RA drugs may cause worsening or death in established heart failure patients, says Sabahat Bokhari, MD, associate professor of medicine-cardiology, and director of nuclear cardiology, Columbia University Medical Center, New York Presbyterian Hospital, New York.