A recent study has showed that depressive symptoms such as anxiety, stress, anger and lack of social support in patients suffering with rheumatoid arthritis (RA) are connected to atherosclerosis, a condition characterized by a rapid build-up of fatty deposits in the arteries, leading to cardiovascular disease. The study was published in the journal of the American College of Rheumatology (ACR), Arthritis Care & Research, and points out how screening and treating psychosocial symptoms might curb the cardiovascular disease burden in RA patients.
According to reports from the Centers for Disease Control and Prevention, 1.5 million Americans are affected by RA, an autoimmune disease that causes fatigue and joint pain, stiffness and swelling. Several studies have proved that cardiovascular disease prevalence is higher among RA patients in comparison to the rest of the population, which justifies the higher mortality observed among this group of patients. However, the reasons underlying these observations are still unknown.
“Understanding the risk factors that lead to greater mortality in those with chronic conditions like RA is extremely important. Our study is the first to investigate the association between psychosocial comorbidities and elevated risk of atherosclerosis in RA patients,” noted Jon Giles, lead investigator and Assistant Professor of Medicine at Columbia University, College of Physicians & Surgeons in New York City.
In this study, data from the Evaluation of Subclinical Cardiovascular Disease and Predictors of Events in Rheumatoid Arthritis Study (ESCAPE) was used, which assessed the progression, prevalence and risk factors for RA patients concerning cardiovascular disease. This cohort included 195 RA patients and 1,073 controls without RA whose coronary artery calcium (CAC) was measured through computed tomography and ultrasound, along with carotid artery thickness for plaque build-up to assess atherosclerosis degree.
The results showed that increased anger and anxiety scores, depression and caregiver stress were linked to a higher risk of CAC in individuals with RA. After adjustment for certain relevant variants, these observations were consistent and appeared only in RA patients and not in the controls.
The team also observed that RA patients had a higher risk of carotid plaque, which was directly related with job stress, while higher social support was correlated to lower carotid intima-media thickness in RA patients. “Our study shows that depression, stress, anxiety, and anger are associated with atherosclerosis markers, which are known predictors of cardiovascular risk in RA. These findings highlight the importance of screening and treatment of heart disease risks factors to limit not only health care costs, but prevent morbidity and mortality for RA patients,” noted Dr. Ying Liu, study’s first author.