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Rheumatoid arthritis (RA) patients with depression, stress, anxiety and anger are at greater risk of developing heart disease, according to new research.

Previous studies have shown that cardiovascular disease is more common among RA patients compared with the general population, although the reasons for this are not yet known.

The new analysis, published in Arthritis Care & Research, a journal of the American College of Rheumatology, reveals that depressive symptoms, stress, anxiety and anger, in patients with a lack of social support, are linked to atherosclerosis — a build-up of fatty deposits in the arteries that contributes to cardiovascular disease.

“Understanding the risk factors that lead to greater mortality in those with chronic conditions like RA is extremely important,” commented lead investigator Dr. Jon Giles, Assistant Professor of Medicine at Columbia University, College of Physicians & Surgeons in New York City. “Our study is the first to investigate the association between psychosocial comorbidities and elevated risk of atherosclerosis in RA patients.”

The researchers used data from the Evaluation of Subclinical Cardiovascular Disease and Predictors of Events in Rheumatoid Arthritis Study (ESCAPE), which examined the prevalence, progression and risk factors for cardiovascular disease in RA.

Medical information on 195 RA patients and 1,073 controls without RA showed that higher anxiety and anger scores, depression and caregiver stress were associated with increased risk of coronary artery calcium greater than 100 units (moderate to severe disease) in patients with RA.

RA patients were also found to have an increased risk of carotid plaque due to job stress. Meanwhile, those with greater social support had lower carotid intima-media thickness.

“Our study shows that depression, stress, anxiety and anger are associated with atherosclerosis markers, which are known predictors of cardiovascular risk in RA,” concluded Dr. Ying Liu, the first author of the study. “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.”