Determining the risk for heart disease

Researchers are beginning to more precisely understand what determines your risk. Such knowledge could help doctors “identify people with high risk as early as possible and intervene to reduce it,” says Dr. Gabriel.

Your doctor can check for heart disease risk factors such as high blood pressure, high cholesterol, excess weight, and your family history of heart disease. He or she can also note your amount of visceral, or belly fat, says Giles: “It’s more highly associated with cardiovascular disease than fat located elsewhere.”

Other tests that may help diagnose heart problems:

  • Sed rate (ESR) or C-reactive protein, which provide a general measure inflammation in your body.
  • An ultrasound test called speckle-tracking echocardiography, which detected early abnormalities in heart function in RA patients in a 2012 study at Mayo Clinic. The test is available now, but used for other conditions.

“However, assessing risk for heart disease in someone with RA can be challenging,” says Gabriel.  For instance, high inflammation, common in people with RA, causes cholesterol levels to drop. “So a doctor may not think a person with RA is at risk for heart disease if she has low cholesterol,” says Gabriel. 

The same is true about weight. “High inflammation is associated with weight loss,” says Gabriel. “So again, a physician may think a thin person with RA has low cardiac risk.”

That’s why researchers are pushing to identify immune system markers (such as the rise of cytokines in response to the cytomegalovirus).

“We are looking at the pattern of the markers, which represents a kind of signature associated with heart disease,” says Gabriel. “But we have a long way to go to develop a signature that can be used in clinical practice.” 

Safeguarding your heart

You can protect your heart in a number of ways.  Here’s how.

  • Stop smoking. “People with RA are more likely to be smokers than people who don’t have RA,” says Gabriel.  “It’s a big culprit.”  According to the American Heart Association, smoking increases blood pressure and blood clotting, both heart disease risks.
  • Exercise.   Exercising when you have RA is tough, but it can be done, especially if you work with a physical therapist who can develop a safe, effective routine for you.  Ask your rheumatologist to refer you to one. The American Physical Therapy Association website,, can also point you to therapists in your area.  Make sure that a therapist has experience working with RA patients.
  • Understand your meds. Nonsteroidal anti-inflammatory drugs (NSAIDs), some TNF inhibitors, and steroids like prednisone can increase heart disease risk, says Gabriel.  Other TNF inhibitors and methotrexate appear to lower risk, probably because they lower inflammation.
  • Work with your rheumatologist. “The focus has to be on managing your underlying disease,” says Gabriel.  That means working with your doctor to keep inflammation levels down and following your medication regimen.  And minimize the traditional risk factors by losing weight, getting treatment for high blood pressure and/or cholesterol, and diabetes, if you have it, says rheumatologist Jon T. Giles, MD, MPH, Assistant Professor of Medicine, Division of Rheumatology at Columbia University Medical Center in New York:

Most of all, be pushy. “Encourage your doctor to be aggressive in evaluating and monitoring your cardiac status,” says Gabriel. “You want her/him to treat you just like any other high risk patient.”