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Statins Can Help Lower the Risk of Cardiovascular Disease in Patients With Rheumatoid Arthritis

By U.S. News & World Report

Rheumatoid arthritis is most commonly associated with joint pain and destruction that can be severe, and even crippling, if the disease is not properly treated or if response to treatment is poor. The damage caused by RA is not confined to the joints, however. RA is a chronic autoimmune disorder that occurs when the body’s immune system begins to attack its own healthy tissue.

As part of this process, the body produces a number of proteins, called cytokines, that cause inflammation throughout the body, targeting multiple organ systems, including the heart and blood vessels. As a result, people with rheumatoid arthritis have an increased risk of developing cardiovascular disease — the No. 1 killer of Americans — compared with the general public.

[See: 7 Surprising Things That Age You.]

“RA patients have higher rates of heart attacks, strokes, sudden cardiac death and heart failure compared with otherwise similar people without RA,” says Dr. Jon Giles, a rheumatologist in New York and an associate professor of medicine in the Division of Rheumatology at the College of Physicians and Surgeons at Columbia University. “Just like in the general population, not everyone with RA will have clinical heart disease,” Giles says. “However, they are more prone to [getting] heart disease.”

Physicians recommend that people with RA follow the normal precautions to lower this risk. These include eating a healthy diet that is low in saturated fats and sugar, exercising, quitting smoking and losing weight. Another strategy that may be especially beneficial is the use of medications known as statins.

According to the Mayo Clinic, statins are drugs that block the production of cholesterol. They may also help the body resorb cholesterol that has already accumulated on blood vessel walls in the form of plaques. When these plaques build up enough to restrict or block blood flow in the heart and brain, heart attacks and strokes can result. Likewise, if plaques break off and enter the bloodstream, they can lodge in the blood vessels of the brain or lungs, causing a stroke or pulmonary embolism.

Statins were introduced in the late 1980s after research showed that they reduce the incidence of a repeat heart attack in people who have already suffered one or more such events. In 2016, the U.S. Preventive Services Task Force recommended that statins be prescribed as a means of preventing a first heart attack or stroke in people with at least one risk factor for cardiovascular disease, including diabetes, high cholesterol and current smoking.

A 2016 study also showed that people with RA can benefit from statin therapy. The researchers found that statins reduced the rate of death for any reason — all-cause mortality — by 21 percent in RA patients compared with similar patients who were not taking statins.

So, if you have RA, should you be taking statins to reduce your risk of cardiovascular disease?

Primary care providers and rheumatologists “are becoming more comfortable prescribing statin therapy directly especially as the association between inflammatory autoimmune disease and cardiovascular disease becomes more and more clear,” says Dr. Shariq Chudhri, clinical assistant professor in the Division of Rheumatology at the University of Arizona College of Medicine in Tucson.

However, Chudhri cautions that more research is necessary before he is willing to prescribe statins to every patient with RA. “At this time, evidence is insufficient to recommend starting statin therapy in patients whose only cardiovascular risk factor is the presence of RA,” he says.

Dr. Shailendra Singh, the rheumatology medical director at the White River Medical Center in Batesville, Arkansas, agrees. “We do not have enough evidence yet to determine if statins are beneficial in [every RA patient, such as] young patients who have new-onset RA and no other risk factors for cardiovascular disease.”

[See: 10 Seemingly Innocent Symptoms You Shouldn’t Ignore.]

“[We do know that] statins reduce the risk of cardiovascular disease in patients with RA who have other risk factors like obesity, diabetes, hypertension, high cholesterol and smoking,” Singh says. “They also reduce the risk in patients who are 50 years or older and have had RA for more than 10 years [but who do not have] other risk factors for cardiovascular disease.”

“I am more likely to start statin therapy in [RA] patients with other cardiovascular risk factors,” Chudhri says.

However, he cautions that statin therapy alone is not enough to ensure optimum risk reduction in people with RA and a history of heart disease.

“In patients with known cardiovascular disease, it is critical to collaborate with a cardiologist in managing a risk reduction strategy for these patients, beyond statin therapy alone,” he says. “We do not hesitate to refer [these] patients to a cardiologist for further evaluation and assistance, if needed,” he adds.

Dr. Eric Matteson, professor of medicine in the Division of Rheumatology at the Mayo Clinic in Rochester, Minnesota, concurs with this approach.

“At Mayo Clinic, we routinely assess our [RA] patients for cardiovascular disease risk in our Cardio-Rheumatology Clinic, a clinic in which cardiologists and rheumatologists work together,” he says. “We individualize the treatment approach according to [the patient’s] past history and a comprehensive assessment of [his or her] cardiovascular risk factors.”

“Studies at Mayo have found that the risk of heart disease has been declining in recent years with improved control of RA,” Matteson explains. “It is our view that it is very important that active RA be brought under control to further reduce cardiovascular risk, as persistent and active disease is a risk for cardiovascular disease.”

[See: How to Practice Yoga When You Have Arthritis or Another Chronic Condition.]

“I routinely prescribe statins to persons [with RA] who have [cholesterol levels] that are known to increase the risk of coronary artery disease,” Matteson says, “but I do not routinely prescribe them to every patient with RA.”

Many different statins are currently available, and the choice of statin is tailored to the patient, depending on specific factors, such as other medications the patient may be taking. “For example, some statins can affect levels of blood thinners, such as Coumadin,” Chudhri says.

So, what is the bottom line?

“Patients with RA and a history of cardiovascular disease should be on statins if they can tolerate them,” Singh says.

More from U.S. News

How to Practice Yoga When You Have Arthritis or Another Chronic Condition

7 Surprising Things That Age You

10 Seemingly Innocent Symptoms You Shouldn’t Ignore

Statins Can Help Lower the Risk of Cardiovascular Disease in Patients With Rheumatoid Arthritis originally appeared on usnews.com

Don’t Settle for Student Loans to Pay for Online Education

By WTOP Staff
Online college programs are becoming a more popular choice for prospective students, with one study finding that more than 6 million students enrolled in at least one online course in fall 2015. The popularity of these courses can be attributed in part to their flexibility with working adults' schedules, students' ability to progress more quickly through online programs and, oftentimes, cheaper tuition. [See 10 low-cost online bachelor's programs for out-of-state students.]Online degrees can be beneficial to many college students, but some studies have shown online learners complete their programs at lower rates than students at traditional brick-and-mortar campuses. Individuals with student loans but no degree comprise two-thirds of defaulted borrowers. Though these numbers are not encouraging, just like for traditional programs, there are ways to reduce how much you'll need to borrow for an online program to ensure you won't become one of these statistics. Don't just settle on borrowing student loans to cover the whole cost of your program and living expenses. Instead, start thinking about how to cut costs and cover your balance in different ways, such as the following. -- Grants and scholarships: Even though you are taking an online course, you can still apply and receive grants and scholarships. But your first step should be to complete the Free Application for Federal Student Aid, commonly referred to as the FAFSA, which will allow you to receive a Pell Grant if your expected family contribution is low enough. The EFC criteria and award amounts are adjusted annually, but the 2017-2018 academic year awards range from $606 to $5,920, which could significantly lower the amount you borrow annually. Your next step is to apply for scholarships. You can start by checking online scholarship search engines, such as the Salt Scholarship Search, College Board's BigFuture and Peterson's. But don't forget to take advantage of local organizations and your school's financial aid office. Both may offer scholarships that you can't find with a national scholarship search. [Review these 10 sites to kick off your scholarship search.]For instance, organizations like the Elks Club, Knights of Columbus or the Rotary Club typically offer scholarships annually to local students. Just because you're going to school online doesn't mean you're ineligible. Visit your local library for scholarship listings, and ask around town. You might be surprised how many local organizations offer scholarships. While these scholarships typically aren't large, every little bit counts. Each dollar you receive in a scholarship is a dollar you don't have to borrow and pay interest on. -- Work-study: Another option for online students may be work-study awards. Not all students enrolled in online programs are eligible, but students at some schools -- including, for example, SUNY Empire State College and Liberty University -- are. Work-study awards are not given upfront like scholarships and grants. In most cases, they are an offer to earn up to the awarded amount if you secure an eligible work-study job. While there is a misconception that all work-study jobs must be on campus, students can work for off-campus, nonprofit or public employers as long as the work is in the public's interest. You may be able to work for a for-profit employer if the job is relevant to your course of study. No matter who the outside employer is, it will need to have an established agreement with your college for you to receive work-study funds. Remember, to be eligible for federal financial aid, you must be enrolled and pursuing a degree or certificate. If you're not working toward a credential, Pell Grants and work-study won't be option, but you may still be able to take advantage of private scholarships -- just be sure to read the eligibility criteria carefully. [Explore what to know about financial aid in online programs.]-- Pay as you go: One of the great benefits to enrolling online is the flexible schedule, which can allow you to complete your college coursework around your responsibilities. But prospective students often overlook using their part- or full-time job earnings as an option for paying for college. Almost 80 percent of college students in 2015 worked at least part time while attending classes, according to the National Center for Education Statistics. By budgeting and thinking strategically about your college costs, you can likely reduce your dependence on student loans by paying a portion out of pocket. Many -- but not all -- online programs are less expensive than traditional programs and often have shorter payment periods. Six, eight or 10 weeks are common course durations. Because of the frequency of payments in an online setting, you may be well-placed to pay as you go and possibly avoid borrowing altogether. Attending college online and avoiding student loans may be challenging, but if you are willing to put in the effort, you can limit the amount you need to borrow. More from U.S. News Q&A: Understanding Student Loan Discharge Eligibility Student Loan Refinancing Isn't Right for All Borrowers
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