Of people aged 65 years or older, 49.6% have reported doctor-diagnosed arthritis according to a 2015 national survey conducted by the CDC. For many older adults, arthritis is seen as an inevitable aspect of aging. However, a matter that is less discussed is the connection between arthritis and the risk of heart disease. Several studies in recent years have elucidated the role of arthritis as a risk factor for CVD, as well as the clinical implications for CVD screening in patients with arthritis.
The risk for CVD has been most clearly demonstrated in patients with rheumatoid arthritis (RA). CDC statistics have shown a 50-70% higher risk for CVD in patients with RA than the general public and nearly half of all adults with heart disease also have arthritis. Risk of stroke, atrial fibrillation, hypertension, and atherosclerosis is also high in those with inflammatory arthritis. The exact mechanism that arthritis plays in CVD is under intense speculation. Research has alluded to the possibility that inflammation related to RA may increase arterial stiffness and cause plaque destabilization, which contributes to a higher risk of major cardiovascular events. Additionally, inflammation may occur at the heart itself. Research has shown pericarditis may occur in 30-50% of patients with RA.
Although the disease process of inflammatory arthritis has been observed to contribute to heart disease, the involvement of medications used to manage arthritis should not be ignored. NSAIDs and selective COX-2 inhibitors are used almost universally as first line agents for pharmacological treatment of arthritis. It is well established in the medical community that these agents increase the risk of serious cardiovascular thrombotic events, which earned the drug class a US black box warning. Corticosteroids which may be prescribed for acute flares are also associated with risk for CVD and attributing ailments such as diabetes and renal impairment.
Eric M. Ruderman, MD, a professor of medicine, associate chief for clinical affairs in the division of rheumatology at Northwestern University Feinberg School of Medicine, and Arthritis Foundation medical advisor, highlights the importance of assessing older adults with inflammatory arthritis for CVD. “For these patients, early recognition of subclinical CVD can lead to more aggressive management of these risks and potential reduction in clinical events,” Ruderman says.
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