The prevalence of coronary heart disease (CAD) and stroke is increased in patients with chronic inflammatory diseases such as rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE). These are also known as IMIDs: immune-mediated inflammatory diseases. Rheumatic IMIDs, including rheumatoid and osteoarthritis, are associated with multiple cardiovascular problems with increased cardiovascular risk, including premature coronary artery disease. Lupus can also worsen coronary heart disease due to the high chronic inflammatory state, increased autoimmune antibodies, and the use of corticosteroids and NSAIDs to treat symptoms.
Social isolation and loneliness also play a role in the disease due to lack of exercise and interactions due to poor health and immunosuppressive medications, leaving the patient very vulnerable to other illnesses. Patients with rheumatoid arthritis (RA) have a notable 50-70% increase in heart disease risk compared to the general population. An increased risk of premature death is also seen in patients with rheumatoid arthritis, largely due to cardiovascular disease.
Pericarditis is another common heart problem associated with rheumatoid arthritis. It is one of the most common cardiac manifestations of RA. It is caused by swelling and irritation of the thin, sac-like tissue surrounding the heart (pericardium). Pericarditis often causes sharp chest pain caused by irritated layers of the pericardium rubbing against each other. It can range from a mild illness that gets better on its own to a life-threatening illness. Fluid buildup around the heart and poor heart function can also complicate the disorder. The result is usually good if pericarditis is treated immediately. Recovery can take two weeks to three months.
Although the incidence of pericarditis observed on an ECG or in postmortem studies reaches 30-50%, clinically it is observed in less than 10% of patients with severe rheumatoid arthritis. This means that many patients have no symptoms and receive no treatment.
While taking steps to reduce heart disease is always a good idea, it is even more essential if you suffer from one or more autoimmune diseases. For example, keeping your blood pressure and cholesterol levels within healthy limits, eating a nutritious diet, controlling stress, getting regular rest and exercise can save lives. Finding a balance between medications and reducing autoimmune disease symptoms through diet and lifestyle changes is fundamental to living with autoimmune diseases. These steps can also help you live with heart disease that can occur with few or no symptoms before it becomes a serious problem.
In many cases, immunosuppressive medications are used to restrict the body's immune response, preventing it from causing further damage. Unfortunately, immunosuppressants make people more susceptible to infections. Precautions should be taken to limit the risk of infection by staying away from crowds, especially during cold and flu season, as well as wearing a mask when going out. Unfortunately, this practice can lead to social isolation and loneliness, which also worsens coronary heart disease, depression and loneliness.
Social isolation is defined as having relatively little in-person social contact, while loneliness occurs when people perceive themselves as isolated, leading them to feel distressed. Although social isolation and feelings of loneliness are related, they are not the same thing. Individuals may lead relatively isolated lives and not feel alone, and conversely, people with many social contacts may still experience loneliness.
Loneliness and autoimmune diseases can often lead to depression, where patients can suffer from cardiovascular disease up to 27% more than those without depression. Social isolation and loneliness are most strongly linked to heart disease and stroke, with a 29% increased risk of heart attack and/or death from heart disease and a 32% increased risk of stroke cerebral. Often, the patient's prognosis is compromised by slower recovery when they are socially isolated and experience loneliness. Depression and loneliness can change the way a person sees or values themselves within the family unit. We may see their place in society become less important or less valuable, which can lead to even more sadness and depression.
Relationships with partners can be very important in supporting the person living with heart or autoimmune disease, as can relationships with friends and family. It's hard to follow food rules when you have to eat alone, and it becomes too much trouble or work to cook for yourself. Given that the association between depression and cardiovascular disease is multifaceted, it may require greater involvement of social workers and caregivers. Depression may also impact traditional cardiovascular risk factors such as diet, exercise, and substance abuse, as well as adherence to medical treatment aimed at primary and secondary prevention of cardiovascular disease.
Both social isolation and loneliness have been clearly shown to be associated with adverse health outcomes. Given the prevalence of social disconnection in the United States, the impact on public health is quite significant. A statement from the American Heart Association highlights the need for more data on strategies to improve the cardiovascular health of people who are socially isolated or lonely and/or struggle with autoimmune diseases, as more and more more evidence showing how these experiences affect brain health becomes relevant.
Nancie Wiseman Attwater is the author of A Caregiver's Love Story.