Re: NEWS: Antirheumatic Therapy May Protect Against Excess MI Risk in RA

[Guest guest]

VERY interesting, a.

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[ ] NEWS: Antirheumatic Therapy May Protect Against Excess

MI Risk in RA

> Antirheumatic Therapy May Protect Against Excess MI Risk in

> Rheumatoid Arthritis

>

>

>

> By Rauscher

>

> NEW YORK (Reuters Health) Aug 31 - Use of disease-modifying

> antirheumatic drugs (DMARDs) seems to lower the increased risk of

> cardiovascular disease associated with rheumatoid arthritis, research

> suggests.

>

> In a nested case-control analysis within a cohort of RA patients, the

> rate of acute MI was significantly lower in current users of any

> DMARD, including methotrexate, leflunomide, and other traditional

> DMARDs, but not with current use of biologic agents.

>

> " Our study, " Dr. Samy Suissa told Reuters Health, " suggests that the

> benefits of these medications (DMARDS) may extend beyond their

> arthritis-remitting effects to cardiovascular effects. This impact

> could be important in view of the elevated rates of cardiovascular

> diseases in patients with rheumatoid arthritis. "

>

> The findings are based on 107,908 RA subjects observed from 1999 to

> 2003. During that period, 558 acute MIs occurred. According to Dr.

> Suissa and colleagues from McGill University in Montreal, the

> adjusted rate ratio was significantly decreased with the current use

> of any DMARD (adjusted RR, 0.80).

>

> " This effect was consistent across all DMARDs, including methotrexate

> (RR, 0.81), leflunomide (RR, 0.28), and other traditional DMARDs (RR,

> 0.67), but not biologic agents (RR, 1.30), " the team reports in the

> August 15th issue of Arthritis and Rheumatism (Arthritis Care and

> Research).

>

> The acute MI rate increased with the use of glucocorticoids (RR,

> 1.32) but not with NSAIDs (RR, 1.05) or COX-2 inhibitors (RR, 1.11).

>

> The reason for decreased AMI risk with DMARD use could be due to the

> drugs' antiinflammatory effects, or " may be an indirect result of the

> beneficial effect of DMARDs on cardiac risk factors in persons with

> RA, " the authors suggest. " For instance, the effectiveness of DMARDs

> in improving physical activity may contribute to a decrease in

> cardiovascular risk factors. "

>

> In addition, glucocorticoids are thought to increase atherosclerotic

> disease, so DMARDs, through their steroid-sparing effect may reduce

> cardiovascular risk.

>

> Dr. Suissa and colleagues point out in their report that the

> cardiovascular effects of the newer DMARDs -- notably, leflunomide

> and TNF-alpha blockers -- are controversial. Some data suggest that

> these drugs may increase blood pressure and lipids, while other data

> hint at a beneficial effect on cardiovascular risk.

>

> " More data will be necessary to ascertain the cardiovascular effects

> of these drugs, " the team concludes.

>

> Arthritis Rheum 2006;55:531-536.

>

>

> http://www.medscape.com/viewarticle/544033