RESEARCH - DMARDs are associated with a reduced risk for cardiovascular disease in patients with RA

[Guest guest]

Arthritis Res Ther. 2006;8(5):R151.

Disease-modifying antirheumatic drugs are associated with a reduced risk for

cardiovascular disease in patients with rheumatoid arthritis: a case control

study.

Department of Rheumatology, VU University Medical Center, Boelelaan 1117,

Amsterdam, 1085 HV, The Netherlands.

Rheumatoid arthritis (RA) is characterized by inflammation and an increased

risk for cardiovascular disease (CVD). This study investigates possible

associations between CVD and the use of conventional disease-modifying

antirheumatic drugs (DMARDs) in RA. Using a case control design, 613 RA

patients (5,649 patient-years) were studied, 72 with CVD and 541 without

CVD. Data on RA, CVD and drug treatment were evaluated from time of RA

diagnosis up to the first cardiovascular event or the end of the follow-up

period. The dataset was categorized according to DMARD use: sulfasalazine

(SSZ), hydroxychloroquine (HCQ) or methotrexate (MTX). Odds ratios (ORs) for

CVD, corrected for age, gender, smoking and RA duration, were calculated per

DMARD group. Patients who never used SSZ, HCQ or MTX were used as a

reference group. MTX treatment was associated with a significant CVD risk

reduction, with ORs (95% CI): 'MTX only', 0.16 (0.04 to 0.66); 'MTX and SSZ

ever', 0.20 (0.08 to 0.51); and 'MTX, SSZ and HCQ ever', 0.20 (0.08 to

0.54). The risk reductions remained significant after additional correction

for the presence of rheumatoid factor and erosions. After correction for

hypertension, diabetes and hypercholesterolemia, 'MTX or SSZ ever' and 'MTX,

SSZ and HCQ ever' showed significant CVD risk reduction. Rheumatoid factor

positivity and erosions both increased CVD risk, with ORs of 2.04 (1.02 to

4.07) and 2.36 (0.92 to 6.08), respectively. MTX and, to a lesser extent,

SSZ were associated with significantly lower CVD risk compared to RA

patients who never used SSZ, HCQ or MTX. We hypothesize that DMARD use, in

particular MTX use, results in powerful suppression of inflammation, thereby

reducing the development of atherosclerosis and subsequently clinically

overt CVD.

PMID: 16984661

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed & cmd=Retrieve & dopt=Abstra\

ctPlus & list_uids=16984661

Not an MD