The raised cardiovascular risk of patients with rheumatoid arthritis is substantially reduced by taking disease modifying antirheumatic drugs, new research suggests.
The Swedish study shows that the increased cardiac risk in patients with rheumatoid arthritis – thought to be caused by inflammatory factors and risk factors that affect the general population – can be modified.
Researchers followed 442 patients from diagnosis for five years, and monitored the progression of their disease using chemical markers of inflammation and physical symptoms. The patients’ treatment regimes were monitored along with risk factors for heart disease, including weight, cholesterol levels, blood pressure, diabetes and smoking.
During the follow-up period, there was a significant increase in treatment for hypertension from 24.5 to 37.4% and in the diagnosis of diabetes mellitus from 7.1 to 9.5%. After five years, 48 patients had suffered a cardiovascular event of which 12 were fatal.
After five years of follow-up 97% of the patients were taking, or had been treated with, DMARDs while 82% had received methotrexate, and 14% had been treated with biological agents.
DMARDs given within three months of diagnosis reduced the risk of a cardiovascular event for individual patients by 60%, compared with that patient’s risk of a cardiovascular event at baseline or at the time of diagnosis.
Any DMARD treatment decreased cardiovascular risk by 12% per month, compared with baseline or at the time of diagnosis.
There was no protective effect seen in patients treated with Cox-2 inhibitors or corticosteroids.
Study leader Dr Solveig Wållberg-Jonsson a rheumatologist at the University Hospital in Umeå, concluded: ‘Inflammation associated with rheumatoid arthritis increases patients risk of heart disease and other cardiovascular events.’
‘However it is possible to reduce this risk in a two-pronged attack by treating both the inflammation and traditional risk factors for heart disease.’
Arthritis Research & Therapy 2011, 13: R131