The prevalence of coronary artery 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 IMID: immune-mediated inflammatory diseases. Rheumatic IMIDs, including rheumatoid and osteoarthritis, are associated with multiple cardiovascular issues with an enhanced cardiovascular risk, including premature coronary artery disease. Lupus can also increase coronary artery disease because of the elevated chronic inflammatory state, the increase in autoimmune antibodies, as well as the use of corticosteroids and NSAIDs to treat symptoms.
Social isolation and loneliness also play a part in the disease due to lack of exercise and interactions because of ill health and immune-suppressing medications, leaving the patient highly susceptible to other diseases. Rheumatoid arthritis (RA) patients exhibit a notable 50% to 70% elevation in heart disease risk compared to the general population. An increased risk of premature death is also observed 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 the 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 condition. Fluid buildup around the heart and poor heart function can complicate the disorder as well. The outcome is usually good if pericarditis is treated right away. Recovery can take from two weeks to three months.
Although the incidence of pericarditis exhibited on an EKG or in post-mortem studies is as high as 30–50%, clinically, it is seen in less than 10% of patients with severe rheumatoid arthritis. This means that many patients don’t have symptoms and go without treatment.
While taking steps to reduce heart disease is always a good idea, it is even more essential if you have one or multiple autoimmune conditions. For example, keeping your blood pressure and cholesterol levels within healthy ranges, eating a nutritious diet, controlling stress, resting, and exercising regularly can be lifesaving. Finding the balance between medications and reducing the symptoms of autoimmune disease with diet and lifestyle changes is fundamental to living with autoimmune diseases. These steps can also help you live with the heart disease that might be happening concurrently with little or no symptoms before it becomes a serious problem.
In many cases, immune-suppressing drugs are used to restrain the body’s immune response, preventing it from doing further harm. Unfortunately, immunosuppressants render people more susceptible to infections. Precautions should be taken to limit the possibility of infections by staying out of crowds, especially during cold and flu season, as well as wearing a mask when out. Unfortunately, this practice can lead to social isolation and loneliness, which also exacerbates coronary artery disease, depression, and loneliness.
Social isolation is defined as having relatively few in-person social contacts, whereas loneliness occurs when people perceive themselves as isolated, causing them to feel distressed. Although social isolation and feeling lonely are related, they are not the same thing. Individuals can lead a relatively isolated life and not feel lonely, and conversely, people with many social contacts may still experience loneliness.
Loneliness and autoimmune diseases can often lead to depression, where patients can experience 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 for heart attack and/or death from heart disease and a 32% increased risk for stroke. Often the patient’s prognosis is guarded with slower recovery when they are socially isolated and are experiencing loneliness. Depression and loneliness can change the way a person sees or values themselves within the family unit. One may see their place in society becoming less important or valuable, and this may lead to even more sadness and depression.
Relationships with partners can be very important in supporting the person who is living with heart or autoimmune diseases, as can relationships with friends and family. It is difficult to follow dietary rules when one has to eat alone, and it becomes too much trouble or work to cook for one. Because the association between depression and cardiovascular disease is multifaceted, it may require more involvement from 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.
It has been clearly demonstrated that social isolation and loneliness are both associated with adverse health outcomes. Given the prevalence of social disconnectedness across the U.S., the public health impact is quite significant. A statement from the American Heart Association highlights the need for more data on strategies to improve cardiovascular health for people who are socially isolated or lonely and/or battling autoimmune diseases as more evidence showing how these experiences affect brain health is becoming relevant.
Nancie Wiseman Attwater is the author of A Caregiver’s Love Story.
