Psychosocial Risk Factors Lead to Cardiovascular Disease in RA

For patients with rheumatoid arthritis, cardiovascular disease and depression seem to be intertwined. RA patients have an increased risk of cardiovascular disease than the general population – and one of the most common symptoms of rheumatoid arthritis and other autoimmune diseases is depression – which is also known to be associated with increased cardiovascular risk. Now, a new study suggests that screening for and treating depression and other psychosocial factors, such as stress, anxiety and anger, could reduce the heart-related morbidity and mortality rates of patients with rheumatoid arthritis. 

• Anger, anxiety, depressive symptoms, stress and low social support were associated with subclinical atherosclerosis.

• Screening and treating psychosocial comorbidities are recommended.

_{Source: Arthritis Care &  Research}

 The study, published online in the August 13 issue of

Arthritis Care and Research

, analyzed data from a longitudinal cohort study of 195 rheumatoid arthritis patients and 1,073 controls. The study compares psychosocial comorbidities as measured by assessment tools (including scales for depression, anxiety, stress, anger and social support) with measures of subclinical atherosclerosis (e.g., coronary artery calcium and carotid plaques) seen on ultrasound and cardiac CT scans. [[{"type":"media","view_mode":"media_crop","fid":"40750","attributes":{"alt":"","class":"media-image media-image-left","id":"media_crop_1054354729130","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4215","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"font-size: 13.0080003738403px; line-height: 1.538em; float: left;","title":" ","typeof":"foaf:Image"}}]]Led by Jon T. Giles, MD, of Columbia University in New York, the researchers write that this is the first-known study to evaluate the association between a wide range of psychosocial comorbidities and subclinical atherosclerosis in rheumatoid arthritis. “Our study showed that anger, anxiety, depressive symptoms, certain types of stress and low social support were associated with markers of subclinical atherosclerosis, including increased coronary artery calcium, carotid intima-media thickness, and plaque presence,  even after adjustment for socio-demographic variables, cardiovascular risk factors, and markers of RA disease activity/treatment and inflammation,” the authors wrote. They suggests treating psychosocial comorbidities could affect both morbidity in RA and reduce mortality associated with cardiovascular disease. The patients were evaluated for factors such as joint swelling, function and disease activity as well as signs of cardiovascular disease. The findings for rheumatoid arthritis patients: 

• Job stress scored on average 4.8 points higher on the anxiety scale (p<0.001). It was associated with a >3-fold increased odds of carotid artery plaque presence (p=0.019).
• Caregiver stress was associated with a greater than 2-fold higher odds of coronary artery calcium (CAC)>100 units (p=0.014).
• Anxiety was associated with a 10% higher odds of CAC>100 units (p=0.029).
• Anger was associated with a 14% higher odds of CAC>100 units (p=0.037).
• In depression, a one-unit higher CES-D score was associated with a 5% higher odds of CAC>100 units with borderline significance (p=0.059).
• Higher levels of social support were associated with lower Internal Carotid Artery Intima-Media Thickness (ICA IMT) levels (p=0.024).

 The researchers note that the excess hear risk in RA can’t be accounted for by either traditional CVD risk factors or chronically elevated systemic inflammation, believed to be a major driver of cardiovascular risk. While they note cohort study data cannot determine cause and effect, Giles and colleagues conclude that “cardiovascular disease and psychosocial risk factors account for much of the morbidity, mortality and costs in RA, and screening and treatment of both are essential in the care of RA patients.” The patients from the study were enrolled in the ESCAPE RA (Evaluation of Subclinical Cardiovascular Disease and Predictors of Events in Rheumatoid Arthritis) Study.