Abstract
ObjectivesDrugs used for the treatment of rheumatoid arthritis (RA) have the potential to affect cardiovascular risk factors. There is concern that corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors could affect cardiovascular risk adversely, while drugs such as the antimalarial, hydroxychloroquine, may have beneficial effects. However, there is limited information about cardiovascular risk factors in patients with RA receiving different drugs.MethodsWe measured cardiovascular risk factors including systolic and diastolic blood pressure, serum HDL and LDL cholesterol, glucose and homocysteine concentrations and urinary F2-isoprostane excretion in 169 patients with RA. Risk factors were compared according to current use of corticosteroids, methotrexate, antimalarials, NSAIDs, COX-2 inhibitors, leflunomide and TNF-α blockers. Comparisons were adjusted for age, sex, race, disease activity (DAS28 score), current hypertension, diabetes, smoking status and statin use.ResultsNo cardiovascular risk factor differed significantly among current users and non-users of NSAIDs, COX-2 inhibitors, methotrexate and TNF-α blockers. Serum HDL cholesterol concentrations were significantly higher in patients currently receiving corticosteroids (42.2 ± 10.5 vs. 50.2 ± 15.3 mg/dL, adjusted P < 0.001). Diastolic blood pressure (75.9 ± 11.2 vs. 72.0 ± 9.1 mm Hg, adjusted P = 0.02), serum LDL cholesterol (115.6 ± 34.7 vs. 103.7 ± 27.8 mg/dL, adjusted P = 0.03) and triglyceride concentrations (157.7 ± 202.6 vs. 105.5 ± 50.5 mg/dL, adjusted P = 0.03) were significantly lower in patients taking antimalarial drugs. Plasma glucose was significantly lower in current lefunomide users (93.0 ± 19.2 vs. 83.6 ± 13.4 mg/dL, adjusted P = 0.006).ConclusionsIn a cross-sectional setting drugs used to treat RA did not have major adverse effects on cardiovascular risk factors and use of antimalarials was associated with beneficial lipid profiles.
Highlights
These patients are treated with a range of drugs including nonsteroidal anti-inflammatory drugs (NSAIDs), selective cyclo-oxygenase-2 (COX-2) inhibitors, corticosteroids and disease modifying antirheumatic drugs (DMARDs) including antimalarials, methotrexate, tumor necrosis factor alpha (TNF-a) blockers and leflunomide
The differences in cardiovascular risk factors between current users and non-user of each particular class of drug are shown in Tables 2 to 8
Statistical models that adjusted for the other drugs under consideration yielded very similar results: there was no change in statistical significance for any comparison except that HDL cholesterol concentrations were significantly higher in patients taking antimalarials (P = 0.03)
Summary
These patients are treated with a range of drugs including nonsteroidal anti-inflammatory drugs (NSAIDs), selective cyclo-oxygenase-2 (COX-2) inhibitors, corticosteroids and disease modifying antirheumatic drugs (DMARDs) including antimalarials, methotrexate, tumor necrosis factor alpha (TNF-a) blockers and leflunomide. In large epidemiological studies DMARDs such as methotrexate appear to decrease cardiovascular mortality [3,4], while COX-2 selective drugs increase it [5,6]. It is important to understand the effects of drugs used to treat RA on cardiovascular risk factors. There is some information about the effects of drugs used to treat RA on risk factors. We examined the hypothesis that drugs used to treat RA affected common cardiovascular risk factors
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