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

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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