OBJECTIVES: Patients with Rheumatoid Arthritis (RA) experience excess cardiovascular (CVD) morbidity and mortality. RA puts patients at twice the risk for myocardial infarction (MI) and stroke, younger patients being at higher risk. We investigate the impact of RA on CVD morbidity in a high risk Medicaid managed care population, largely female, African American, young adults, with baseline risk factors of hypertension and diabetes. METHODS: Maryland Medicaid claims data for patients with diabetes and/or hypertension, from January 2001-June 2006 were analyzed. Using exploratory analysis, we assessed the prevalence of RA and of CVD, as well as the prevalence of CVD within the RA population. Logistic regression analysis was used to explore the joint impact of RA, demographics, hypertension and diabetes on the likelihood of having a CVD event. RESULTS: The prevalence RA was 2.2% among patients at high-risk for CVD. Patients with RA were significantly older (mean age 49 vs. 34, p<0.0001), largely females (80% vs. 64%, p<0.0001) and non-African American (55% vs. 59%, p<0.0001) than those without RA.  CVD prevalence was significantly higher in the RA population among compared to the general population (37% vs. 17%).  After adjusting for demographics (age, gender, race) and risk factors (hypertension, diabetes), RA significantly increased the likelihood of CVD events (OR: 1.539, 95% CI: 1.416-1.674). In the adjusted model, hypertension (OR: 3.227) and diabetes (OR: 2.035) also independently increased the likelihood of CVD events. CONCLUSIONS: We found that RA independently increased cardiovascular risk by 1.5 times, in a Medicaid population with high baseline risk.