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If you have rheumatoid arthritis, you should be worried about risk from cardiovascular events. That includes both heart attacks and strokes.

Women with rheumatoid arthritis (RA) have high rates of non fatal heart attacks. This occurs even without traditional risk factors being present. (Solomon, et al. Circulation 2003; 107: 1303-1307). The same is probably true for men with RA as well.

In addition multiple studies have demonstrated the increased risk of stroke occurring in patients with rheumatoid arthritis. Presence of intimal plaque (atherosclerosis in the inner walls of the carotid arteries) has been used as a surrogate marker of arterial disease elsewhere.

The conclusions drawn from multiple studies are that RA is an extremely potent risk factor for the development of atherosclerosis. More aggressive goals for risk factor modification should be instituted.

It's important to assess all risk factors in patients with RA. Control of hyperlipidemia and high blood pressure is mandatory. Dietary measures are primary. If dietary changes don't work, then statin therapy maybe needed. These drugs lower LDL cholesterol ('bad' cholesterol) and reduce levels of C-reactive protein. If a patient has diabetes, tight control of blood sugar is extremely important.

Discontinuation of cigarette smoking and proper weight management are important.

Rheumatoid arthritis (RA) patients could reduce their cardiovascular risk by spending more time walking.

Physical inactivity and sedentary behavior contribute to the risk of cardiovascular disease but little is known about energy expenditure from lifestyle physical activity in RA patients.

A recent study compared energy expenditure from exercise and lifestyle activities between 122 RA patients and 122 healthy controls.

At the beginning of the study, RA patients spent fewer kilocalories per week walking, exercising and participating in sports than did controls, the authors report.

Similar percentages of RA patients and controls met their recommended thresholds for total weekly energy expenditure, but the percent of RA patients meeting the recommended threshold for walking (32%) was notably lower than controls (48%).

At follow-up an average of 14 months later, RA patients continued to expend fewer kilocalories per week overall and were less likely to meet the threshold for walking, compared with controls.

"This study provides evidence that despite the fact that walking is an excellent lifestyle activity and it is markedly underutilized in RA patients," the authors note. "Our study supports the development and implementation of interventions to foster walking as part of a program to address cardiovascular risk in RA patients." (Mancuso C, et al. Arthritis Rheum 2007; 57:672-678).

Aspirin therapy has been shown to be effective prophylaxis for men and some studies also indicate its potential effectiveness in women.

In the final analysis, it must be mentioned that the most potent weapon against the increase in cardiovascular mortality is tight control of the rheumatoid arthritis- getting the disease into remission. Fortunately, the advent of first, second, and third generation biologic medicines have made this a reality.