Does rheumatoid arthritis treatment affect the risk of cardiovascular disease?

This study investigated the effect of disease-modifying anti-rheumatic drugs (DMARDs) on cardiovascular disease (CVD) risk.

They found that abatacept (Orencia) and tumor necrosis factor inhibitors (TNFi) were associated with decreased CVD risk.

Rheumatoid arthritis (RA) is a chronic condition. It is caused by painful inflammation and swelling in the joints. RA is treated with disease-modifying anti-rheumatic drugs (DMARDs). There are different types of DMARDs. Synthetic DMARDs (csDMARDs) have been around for many years. Biological DMARDs (bDMARDs) are a newer types of DMARDs.

Patients with RA have a 50% higher risk of cardiovascular disease (CVD). The reason for this is not clear. Inflammation in RA can cause a build-up of inflammation cells in blood vessels. This could lead to blockages. It is unclear if the risk of CVD is different with csDMARD or bDMARD treatment. 

This study included 18,754 patients with RA. The authors analyzed the rates of CVD outcomes. These included heart attack, stroke, heart failure, and death. bDMARD or csDMARD treatment was prescribed as per the doctor’s request. The authors compared treatment and CVE outcomes. The average follow-up time was 4 years. 

Tumor necrosis factor inhibitors (TNFi) were associated with a 19% reduced risk of CVD. TNFis include drugs like adalimumab (Humira), etanercept (Enbrel), or infliximab (Remicade). Abatacept was associated with a 50% reduced risk of CVD. Particularly, abatacept was associated with a 67% reduced risk of a heart attack compared to csDMARDs. TNFi and abatacept are bDMARDs. Other bDMARDs were not associated with any impact on the risk of CVD.

Of the TNFis, infliximab and etanercept were associated with the most significant reduction in risk of CVD.

Glucocorticoids (GCCs) were associated with a 15% higher risk of CVD. The use of methotrexate (Otrexup) was associated with an 18% lower risk of CVD. GCCs and methotrexate are considered to be csDMARDs.

The authors concluded that abatacept and TNFi were associated with decreased CVD risk in patients with RA.

The number of CVD events was lower than expected in this study. This could be because healthier people were more likely to take part in a trial. This means that the effect of bDMARDs or csDMARDs on high-risk CVD patients could be different. More studies are needed. 

If you have any concerns regarding RA management please consult with your physician.