Coronary heart disease 'silent cause of RA death' | Arthritis Information

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Rheumatol Int 2008; Advance online publication

MedWire News: Coronary heart disease remains largely unrecognized as a cause for death in patients with rheumatoid arthritis (RA), results from a long-term study of autopsy data indicate.

"Very few RA mortality series examine changes in specific causes of death over time," explain Riitta Koivuniemi (Helsinki University Central Hospital, Finland) and colleagues.

Indeed, previous studies into the cause for death in patients with RA have contradicted each other and have been based on clinical diagnosis, rather than autopsy data, and so may be unreliable.

For their study, Koivuniemi and co-researchers looked at data concerning the causes for death for 369 individuals with RA, produced by clinicians and pathologists before the autopsy. These data, collected over a period of up to 40 years, were then compared with similar data for 370 individuals without RA.

As expected, autopsy-determined cause of death in RA patients was usually RA itself, cardiovascular disease, or infection.

Of note, however, agreement about cause of death between clinicians and pathologists was lower in patients who had had RA than in those who had not.

Death of RA patients from gastrointestinal disease was most commonly misdiagnosed by clinicians.

The exception to the rule was in patients with RA treated with disease-modifying anti-rheumatic drugs, for whom cause of death was usually the same when given by a clinician or a pathologist.

Notably, the number of deaths caused by coronary heart disease significantly decreased after the 1970s in those individuals without RA while it did not change in those with RA.

"Our results indicate that RA patients may suffer from silent coronary heart disease," the authors write in the journal Rheumatology International.

"An active search for coronary heart disease and its effective treatment, with its risk factors-including active RA-is important to reduce cardiovascular mortality in RA," the investigators add.

Hi Lynn, this is the reason why I've been proposing that everyone with an RA or PsA diagnosis have a cardiac workup and then follow-up early.  Have been reading several studies and recommendations regarding this.  Last year I had a cardiac issue directly related to RA.  Fortunately it was caught early in the process and will be watched closely by my cardiologist and internist.  I really think  that a cardiac workup and follow-ups are a vital part of good RA medicine.  If your RD or primary haven't recommended a workup then request an EKG and referral to a cardiologist for some baseline studies.  It's good preventative medicine.  LindyI agree with you LinB.  As someone who has a strong family history of heart disease, one of the first things my RD did was order a cardiac workup.  Both my RD and PCP keep a close eye and stay on top of this.  It really is very important for everyone with RA to aware of the link between RA and coronary heart disease ........It saves lives!
Lynn
My second visit with my RD she thought she heard a slight murmor, and sent me for an echo. It came back perfect, but because of the dizzy spells, accompanied with hot flashes and nausea, she is recommending I see a cardiologist. I'll be seeing my primary first, but after reading this, makes me realize that is isn't such a bad idea going to the cardiologist anyway. I feel I'm too young to have a coronary issue, but my dad had heart issues at a young age, not as young as me, but young enough to be concerned. Thanks for posting this, Lynn.Lots of docs consider an elevated CRP a 'harbinger' of cornary artery disease. If your meds control your inflammation well as measured by CRP your risk for coronary artery disease goes down.
 
It is a good idea for RA patients to act on all the healthy heart guidelines. Ideal body weight, exercize, lower salt intake, lower saturated and trans fat intake, adequate rest, reduction of stress....all nearly impossible for me and NUMBER1 NO SMOKING!

Yes, that's an important observation Marian. Elevated CRP can be a "harbinger" of coronary artery disease and it's important to know that the inflammation caused by R/A can cause problems within the cardiovascular system. After 15 years of R/A I had a heart bypass. My cardiologist attributed problems in my left anterior descending artery to inflammation caused by R/A. Like many people I had never bothered to check my heart status with a competent cardiologist. A few bucks spent on a proper cardiovascular check is worth your life. And yes, smoking is out, exercize is in, and trying to stay stress-free  (if you can) are crucial in helping manage the incidence and effects of inflammation in R/A.

Food for thought...Moving this back up
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