Why PsA puts you at greater risk for heart disease.

In addition to causing joint pain and stiffness, PsA can affect other parts of your body, like your heart and blood vessels. People with PsA have a higher risk of developing heart disease or stroke compared to people without PsA.  

The good news is that just because you have PsA doesn’t mean that you will develop heart disease or stroke. With the right screening and preventive health measures you can reduce your risk and keep your heart and blood vessels healthy. You should talk to your doctor if you are concerned about heart disease.

What is heart disease?

Heart disease is a term that is used to describe a range of different conditions that affect the structure and function of the heart. Heart disease is part of a group of conditions, known as cardiovascular disease (CVD,) which affect the heart and blood vessels. The most common and serious types of CVD include:

• Coronary heart disease (CHD). This occurs when fatty material (plaques) builds up in the arteries that carry blood to the heart, reducing the flow of blood.  The two most common types of CHD are angina and heart attack.
• Angina occurs when temporary poor blood flow to the heart causes chest pain.
• Heart attack occurs when one of the blood vessels supplying the heart with oxygen becomes completely blocked.
• Heart failure occurs when the heart can’t pump enough blood around the body. Some potential cause of heart failure includes heart attack, high blood pressure and heart valve problems
• Stroke occurs when blood cannot get to the brain because of a blocked or burst artery, causing damage.

Why does psoriatic arthritis increase the risk of heart disease and what can you do to protect yourself?

There are two main reasons why people with PsA have an increased risk of CVD: chronic inflammation and shared risk factors.

Substances called ‘cytokines’, that are involved in the inflammation that damages the joints in PsA, can also damage blood vessels, increasing the risk of CVD. Inflammation causes plaque build-up in the arteries, which slowly narrows blood vessels and reduces blood flow. This increases the risk of having a heart attack or stroke.

The other reason people with PsA are more likely to develop heart disease is shared risk factors.

These shared risk factors include: 

High blood pressure

A number of factors can increase blood pressure in people with PsA, including low levels of exercise due to sore joints. Some of the medicines used to treat PsA, such as non-steroidal anti-inflammatory drugs (NSAIDs) or corticosteroids, can also increase blood pressure. If left untreated, over time high blood pressure can damage the blood vessels and the muscle of the heart, contributing to the risk of heart attack or heart failure.

Metabolic Syndrome

Metabolic syndrome is a collection of conditions that occur in the body at the same time. A person is diagnosed with metabolic syndrome when they have 3 or more of the following:

• Obesity
• Raised blood pressure
• High levels of triglycerides (a type of fat found in the blood)
• High cholesterol
• High blood sugar.

Metabolic syndrome is more common in people with PsA than the general population and increases the risk of CVD.

Obesity 

Sore joints make it hard to exercise and low levels of physical activity can lead to weight gain. Medicines such as corticosteroids which may be used to manage PsA, have also been linked to weight gain.  Obesity increases the risk of CVD as well as other risk factors such as high blood pressure and high blood sugar. Fat cells also make certain proteins that lead to inflammation and increase CVD risk.

Smoking

In addition to making PsA symptoms worse, smoking increases blood vessel damage and narrowing of the arteries. Because of this, smokers have a higher risk of CVD than non-smokers.

Abnormal lipids

PsA has an unusual effect on lipids (fats) in your blood. This is often known as ‘dyslipidaemia’. People with PsA tend to have high levels of triglycerides and low levels of high-density lipoproteins (‘good’ cholesterol). This combination can increase the risk of cardiovascular disease.  

You can reduce your risks

While this information may be overwhelming, there are things you can do to protect your heart and reduce the risk of heart disease.

One of the best ways to protect your heart is by taking the disease-modifying anti-rheumatic drug (DMARD) your rheumatologist prescribes. These medicines work to control PsA disease activity which may also reduce the risk of heart attack, stroke and other cardiovascular events. 

When it comes to lifestyle interventions, the same advice applies whether you have PsA or not. 

Stay active - Doing aerobics and strengthening exercises on most days of the week can protect your blood vessels, help you lose weight and reduce the risk of heart disease. There’s also evidence that exercise can fight inflammation. Read Exercise and psoriatic arthritis for more information about how to stay active while living with PsA.

Eat well - Add extra fruits and vegetables to your diet. Eat fatty fish like salmon and tuna, which are high in anti-inflammatory omega-3 fatty acids. Avoid highly processed and ‘fast foods’ as these contain high levels of saturated and trans fats, which contribute to weight gain and heart disease.  Read Healthy eating for more information. 

Control stress - Practise relaxation techniques like deep breathing and meditation and try and live mindfully to control stress and reduce its impacts. Read Meditation and arthritis for relaxation tips.

Quit smoking - Quitting smoking can be hard but it’s not impossible. There are a number of methods to help you quit, such as nicotine replacement therapy, medications or counselling. Speak with you doctor about what methods are available, call the Quitline on 13 78 48 or go online at icanquit.com.au. The Quitline also has Aboriginal and multilingual advisors available.

Watch your numbers - Have your blood sugar, blood pressure and cholesterol levels checked regularly. If they are high, speak with your doctor. They may recommend that you try to lower them with diet and exercise or may prescribe you medications to help if necessary. 

Find alternate pain-relieving methods - Some medications that are effective at relieving pain and bringing down inflammation can also increase your risk of heart disease. Talk to your doctor about your treatment options. Try to use the smallest dose needed to manage your pain for the shortest time possible. Try other pain relief methods as well, such as heat, ice or physical therapy.  Read Dealing with pain for more information.

Monitor your heart health

When you have PsA, you need to keep an eye on your heart health. Your rheumatologist or GP is likely to recommend regular tests of your blood pressure, blood sugar and cholesterol.

The European League Against Rheumatism (EULAR) recommends heart health screening at least once every five years and every time you change your PsA medication. Your doctor may also want to do a stress test, echocardiogram or electrocardiogram to check your heart health. These are non-invasive tests that check how your heart performs while doing activity.

Be watchful for any symptoms of heart disease, such as shortness of breath, chest pain, or arm pain and report them to your doctor right away.

For more information about how to maintain a healthy heart, visit The Heart Foundation www.heartfoundation.org.au

This resource has been developed based on the best available evidence. A full list of references is available upon request.