Rheumatoid Arthritis and Cardiovascular Disease
Patients with RA are typically managed by several physicians, and coordination of care may be suboptimal. Smoking cessation and control of standard risk factors are all indicated in patients with RA but may be underused because of the understandable focus on management of RA itself. Despite the well-understood benefits of exercise on general and CV health, most patients with RA do not pursue a regular exercise program. Both aerobic exercise training and resistance exercise training for patients with RA have been shown to be efficacious in improving overall well-being, the muscle mass loss associated with RA, and markedly improving physical function without exacerbating disease activity and is likely to reduce CV risk and should be part of routine care.
There is evidence that patients with RA are less likely to receive both primary and secondary heart disease preventions. Only 55% of patients with RA in one study had lipid levels measured; management by rheumatologists was associated with less lipid screening. Rheumatologists were less likely to identify and treat cardiac risk factors than primary care physicians. Angina may also be underdiagnosed, with chest pain attributed to RA instead of CAD, perhaps because the increased risk of CAD is not understood by treating physicians, and referral to a cardiologist is less likely. Patients with RA and an acute MI were less likely to receive reperfusion therapy and secondary prevention medications, such as β-blockers and lipid-lowering agents. Patients with RA were also less likely to undergo coronary artery bypass grafting than patients without RA.
Heart Disease Management/Outcome in RA
Patients with RA are typically managed by several physicians, and coordination of care may be suboptimal. Smoking cessation and control of standard risk factors are all indicated in patients with RA but may be underused because of the understandable focus on management of RA itself. Despite the well-understood benefits of exercise on general and CV health, most patients with RA do not pursue a regular exercise program. Both aerobic exercise training and resistance exercise training for patients with RA have been shown to be efficacious in improving overall well-being, the muscle mass loss associated with RA, and markedly improving physical function without exacerbating disease activity and is likely to reduce CV risk and should be part of routine care.
There is evidence that patients with RA are less likely to receive both primary and secondary heart disease preventions. Only 55% of patients with RA in one study had lipid levels measured; management by rheumatologists was associated with less lipid screening. Rheumatologists were less likely to identify and treat cardiac risk factors than primary care physicians. Angina may also be underdiagnosed, with chest pain attributed to RA instead of CAD, perhaps because the increased risk of CAD is not understood by treating physicians, and referral to a cardiologist is less likely. Patients with RA and an acute MI were less likely to receive reperfusion therapy and secondary prevention medications, such as β-blockers and lipid-lowering agents. Patients with RA were also less likely to undergo coronary artery bypass grafting than patients without RA.