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Link between rheumatoid arthritis and cardiovascular disease explained

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According to a new study, mental health problems like anxiety and depression may explain why people with rheumatoid arthritis (RA) have an increased risk of cardiovascular disease. According to the study, anger, anxiety, depressive symptoms, job stress and low social support was linked to increasing risk of hardening of the arteries, or atherosclerosis for people with RA.

In the study, Dr. Jon T. Giles of Columbia University College of Physicians and Surgeons in New York City and team compared 195 patients with RA and no history of heart problems to more than 1,000 similar adults without arthritis. Study participants with RA had more depressive symptoms, higher personal (such as caring for a loved one) and health stress, higher job stress and lower relationship stress. These listed psychosocial problems, on top of higher anxiety scores and anger scores, were associated with increased odds of coronary artery calcium. Furthermore, job stress increased the risk of plaque in the carotid artery in the neck, which helps supply blood to the brain. In the comparison group, there was no relation between the aforementioned psychosocial factors and artery calcium.

When Reuter’s Health emailed Dr. Ivana Hollan of the Hospital for Rheumatic Diseases in Lillehammer, Norway, who was not involved in the study, about the study, she replied: “Depression may be up to four times as common for people with RA compared to the general population. Emotional changes seem to have a causal role in cardiovascular disease. Depression increases the risk for cardiovascular disease, and among those who have cardiovascular disease, depression predicts worse disease outcomes. The treatment of psychosocial conditions, such as depression, appears important as these conditions have health effects beyond their impact on mood.”

Dr. Ganz, chief of cardiology at San Francisco General Hospital, who was not involved in the study, said that for people with RA, inflammation is most evident in the joints but is present “systematically” in many parts of the body. Inflammation is also a key component of atherosclerosis, which can lead to heart attack and stroke. When someone has both osteoarthritis and RA, the RA intensifies the inflammatory processes in the arteries, making the plaques worsen more rapidly and raising the risk of heart attacks, strokes, and other complications.

The study concludes that treating psychosocial problems may help ease arthritis symptoms as well as decrease the risk of death from cardiovascular disease. Ganz adds: “Lifestyle improvements (exercise, healthy diet, weight control, cessation of smoking) should be encouraged and pharmacological approaches (e.g. statins for cholesterol reduction, aspirin) should be considered to reduce cardiovascular risk.”