Rheumatoid arthritis and cardiovascular disease association explained by mental health problems
According to the recent study, the reason for increased risk of cardiovascular disease in patients with rheumatoid arthritis (RA) can be partially explained by the mental health problems like anxiety and depression. Anger, anxiety, depressive symptoms, job stress and low social cause increased risk of hardening of the arteries, or atherosclerosis, for people with RA were linked by the researchers.
The study team in the journal Arthritis Care and Research concluded that reduction in the symptoms of arthritis and decrease in the risk of death from cardiovascular disease can be achieved by treating psychosocial problems. RA, an autoimmune disease, can strike at any point in life in which the body's immune system starts attacking the joints, causing swelling, pain and increased inflammation.
Dr. Peter Ganz told Reuters Health by email that the inflammation is mostly marked in joints but is present systemically in many parts of the body. While not involved in the study, Dr. Ganz, chief, Cardiology, San Francisco General Hospital, believes that inflammation is a major component of atherosclerosis, from its beginning to its ultimate consequences, like heart attack and stroke. He said that RA deepens the inflammatory processes in the arteries, worsening plaques rapidly and also raising the risk of heart attacks, strokes and other complications. Psychological stress also increases inflammation. So one might have a triple whammy - inflammation from atherosclerosis, RA and psychosocial stresses all converge in the same patient.
Patients (n=195) with RA and no history of heart problems to more than 1,000 similar adults without arthritis were compared by Dr. Jon T. Giles, Columbia University College of Physicians & Surgeons, New York City and colleagues for the new study. RA patients had more depressive symptoms, higher personal health stress, higher job stress and lower relationship stress but less anger than the comparison (non-arthritis) group. In RA group, higher anxiety scores, anger scores, more symptoms of depression, and stress were associated with increased odds of coronary artery calcium while no such relation between psychosocial factors and artery calcium was seen in the comparison group.
In RA, risk of plaque in carotid artery in the neck (known to supply blood to brain) was increased by job stress. According to Dr. Ivana Hollan, Hospital for Rheumatic Diseases, Lillehammer, Norway, depression is approximately 4 times common in RA patients than general population. She told Reuters Health that emotional change seems to have a causal role in cardiovascular disease and risk for cardiovascular disease is increased by depression. Hollan feels that psychological conditions like depression should be treated and should be considered important as such conditions put a negative impact on health more than mood.
On the basis of this study, Ganz said that stress must be reduced in the lives of RA patients preferably with counseling. In his opinion, both lifestyle improvements (exercise, healthy diet, weight control, cessation of smoking) and pharmacological approaches (e.g. statins for cholesterol reduction, aspirin) should be considered to reduce cardiovascular risk.