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But that risk can be spotted and hopefully modified by using the same criteria used to identify heart-disease risk in the general population, a new study suggests.
Those screening checks include high blood pressure, high cholesterol, older age, and family history of cardiovascular illness. And people diagnosed with rheumatoid arthritis (RA) should be screened using those risk factors as soon as possible following their diagnosis of RA, the study authors said.
"The bottom-line is that RA patients are at increased risk of heart disease," said lead researcher Dr. Hilal Maradit Kremers, a research associate with the Mayo Clinic Department of Health Sciences Research in Rochester, Minn.
"But we need to know how can we predict which RA patients are at a higher risk than others, so that we can then put more effort in the prevention of heart disease in these people," she added. "And so, here we attempted to do just that, by using a typical cardiovascular risk profile to predict heart disease among these patients."
Kremers and her colleagues presented their findings this week at the American College of Rheumatology annual meeting, in Boston.
The study findings follow a 2005 Mayo Clinic report that suggested that the increase in heart disease risk among RA patients may be due to the systemic inflammation brought on by the disease, which, in turn, prompts arterial plaque to form blood clots. The new findings also come on the heels of a Mayo Clinic study released last month that said RA patients are more than twice as likely to develop heart failure over a 15-year period than people who don't have the disease.
According to the Arthritis Foundation, rheumatoid arthritis is a chronic and often disabling disease with no known cause or cure that affects just over 2 million Americans. It's characterized by inflammation of the lining of the joints and, over time, can lead to joint damage, severe pain, and immobility.
Treatments -- such as nonsteroidal anti-inflammatories, analgesics and physical therapy -- focus primarily on controlling pain and limiting inflammation and joint destruction.
For the new study, Kremers and her colleagues set out to predict the onset of heart disease over the course of a 10-year period among more than 1,100 people, approximately half of whom had just been diagnosed with RA. The patients were 57 years old, on average, and nearly three-quarters were women.
The patients were evaluated on standard indicators for heart disease risk, as detailed by the American Heart Association. The indicators included: gender; having a family history of heart disease; having diabetes; and/or being black. Patients were also examined for other risk factors, such as high cholesterol and high blood pressure. Risky lifestyle habits -- including smoking, lack of exercise, and being overweight -- were also considered, the researchers said.
Based on the risk-assessment scores, the researchers assigned the patients to one of five different risk categories for heart disease -- ranging from very low to very high risk. Then the patients were tracked for an average of 12 to 14 years, during which time all incidences of heart attack, heart failure, heart surgeries, and cardiovascular-related deaths were noted.
The researchers found that while 85 percent of the RA patients between the ages of 50 and 59 had an intermediate or high risk for developing heart disease within 10 years of diagnosis, just 27 percent of comparable non-RA patients did. Among patients between the ages of 60 and 69 at the start of the study, 100 percent of the RA patients had an intermediate or high risk for heart disease, compared with 79 percent of non-RA patients.
When looking at just "high risk" among the 60 to 69 age group, the difference was even more dramatic: 85 percent for RA patients, compared to just 40 percent for non-RA patients.
The researchers concluded that more than half of RA patients 50 to 59, and all RA patients over the age of 60, had a 10 percent or greater risk of developing heart disease within 10 years of an RA diagnosis.
In light of the findings, the Mayo researchers are encouraging doctors to conduct heart-disease assessment screenings similar to the ones used in the study for each of their RA patients. These screenings should be done as soon as possible following an RA diagnosis and prevention strategies put into place, the researchers said.
"By simply doing the things that we already know, such as measuring blood pressure, blood sugars, and cholesterol -- all the standard things that we look at for the general population -- we can help identify the risk for a major cardiovascular event among the RA population," Kremers said.
Dr. Hayes Wilson, chief of rheumatology at Piedmont Hospital in Atlanta, said he endorsed the Mayo researchers' work.
"Anything that helps us characterize and categorize risk factors helps us in the treatment of the disease," he said. "And, until we can figure out what the smoking gun is, hopefully this advice will help us prevent cardiovascular disease or related diseases by helping RA patients better appreciate the risks they face."
SOURCES: Hilal Maradit Kremers, M.D., research associate, Mayo Clinic Department of Health Sciences Research, Rochester, Minn.; Hayes Wilson, M.D., chief, rheumatology, Piedmont Hospital, Atlanta, and medical adviser, Arthritis Foundation, Atlanta; American College of Rheumatology annual meeting, Nov. 6-11, 2007, Boston
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