Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


TNF-alpha Blocking Therapy Lowers Cardiovascular Risk in Rheumatoid Arthritis.

Visman1,  Ingrid M., van Sijl3,  Alper M., Peters5,  Mike J. L., Dongen1,  Carlo J. J. van, Dijkmans4,  Ben A. C., Nurmohamed2,  Michael T.

Jan van Breemen Institute
Jan van Breemen Institute and VU Medical Centre, Amsterdam, The Netherlands
Jan van Breemen Institute and VU Medical Centre
VU Medical Centre, Amsterdam, The Netherlands
VU Medical Centre

Background:

Patients with rheumatoid arthritis (RA) have an increased risk of developing cardiovascular (CV) disease and the underlying chronic inflammatory process appears to play a pivotal role. As tumor-necrosis factor (TNF)-alpha blocking agents have powerful anti-inflammatory effects it is conceivable that these agents will lower CV risk in RA. The objective of this study was to compare the CV disease incidence rate in RA patients receiving TNF-alpha blocking therapy with RA patients not receiving these drugs.

Methods:

Two prospective cohort studies of individuals with RA (the CARRÉ study and the Biologicals-cohort of the Jan van Breemen institute in Amsterdam, the Netherlands) were followed for several years. The CARRÉ study is a prospective cohort of individuals with RA, most of whom did not use biologic agents at inclusion. Patients who did use biologicals were excluded from further analysis. The Biologicals-cohort is a prospective cohort of adult RA patients starting therapy with TNF-alpha blocking agents. Data was collected regarding traditional cardiovascular risk factors, RA related factors, cardiovascular morbidity and mortality. Cardiovascular events were defined as objectified myocardial infarction, cerebrovascular accident, transient ischaemic attack, peripheral arterial reconstruction, or coronary stent- or by-pass procedure. Cox proportional hazard model was used to evaluate the difference in cardiovascular incidence between both groups and models were adjusted for age, sex and previous cardiovascular disease.

Results:

377 and 322 individuals, with and without TNF-alpha blocking therapy, respectively, were followed for a mean duration of 2.1 and 2.7 years, resulting in 793 and 888 patient years, respectively. Cardiovascular incidence was 10.1/1000 patient years and 24.8/1000 patient years, respectively. Cox proportional hazard model showed a statistically significantly decreased cardiovascular incidence in individuals using TNF-alpha blocking therapy, hazard ratio (95%-confidence interval): 0.42 (0.18–0.97). After adjustment for age, gender and previous CVD there was still a 30% lower cardiovascular risk in RA patients treated with TNF-blockers, but this was not longer statistically significant (hazard ratio (95%-confidence interval): 0.71 (0.29–1.72).)

Table 1. Incidence of cardiovascular risk factors and cardiovascular events

 Carre cohort (n=322)Biologicals cohort (n=377)
 CasesIncidence rate per 1000 patient yearsCasesIncidence rate per 1000 patient years
All cause mortality1011.334.1
All CV-events2224.8810.1
IHD1314.622.7
CVA/TIA55.645.5
PAD33.422.7

Figure 1. Cox-regression analyis of cardiovascular event free probability for patients with and without TNF-blocking therapy, corrected for age, gender and previous CVD.

Conclusions:

This investigation strongly suggests that TNF-blocking agents indeed lowers the cardiovascular risk in RA. However, confirmatory investigations are still required.

To cite this abstract, please use the following information:
Visman, Ingrid M., van Sijl, Alper M., Peters, Mike J. L., Dongen, Carlo J. J. van, Dijkmans, Ben A. C., Nurmohamed, Michael T.; TNF-alpha Blocking Therapy Lowers Cardiovascular Risk in Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :90
DOI: 10.1002/art.27859

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