Some arthritis drugs may protect the heart
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In patients with rheumatoid arthritis, use of disease-modifying antirheumatic drugs, or 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 heart attack was significantly lower in current users of any DMARD, including methotrexate, leflunomide (Arava), and other traditional DMARDs, but not with current use of newer “biologic” DMARDs.
“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,” Suissa said.
The findings are based on 107,908 rheumatoid arthritis patients observed from 1999 to 2003. During that period, 558 heart attacks occurred. According to Suissa and colleagues from McGill University in Montreal, the adjusted rate ratio for heart attack was significantly decreased with the current use of any DMARD.
This effect was consistent across all DMARDs, including methotrexate, leflunomide, and other traditional DMARDs, but not biologic agents, the team reports.
The heart attack rate increased with the use of glucocorticoids but not with non-steroidal anti-inflammatory drugs or COX-2 inhibitors.
The reason for decreased heart attack risk with DMARD use could be due to the drugs’ anti-inflammatory effects, or “may be an indirect result of the beneficial effect of DMARDs on cardiac risk factors in persons with rheumatoid arthritis,” 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.
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.
SOURCE: Arthritis and Rheumatism (Arthritis Care and Research) August 15, 2006.
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