Abstract
BackgroundFew studies have evaluated the association between the risk of coronary artery disease (CAD) and the use of Chinese herbal products (CHP) in patients with rheumatoid arthritis (RA). This study investigated the risk of CAD among patients with RA using CHP in combination with conventional medicine.MethodsA retrospective cohort study was conducted using the Taiwan National Insurance Research Database to assess 22,353 patients who had been newly diagnosed with RA between 1997 and 2010. Patients were assigned to the CHP group or non-CHP group according to their use or nonuse of CHP after being diagnosed with RA. The Cox proportional hazards model was used to estimate the hazard ratio (HR) of CAD for a 1:1 matched sample.ResultsBoth the CHP and non-CHP groups comprised 4889 patients after 1:1 matching. The risk of CAD was significantly reduced in the CHP group [adjusted HR (aHR): 0.59, 95% confidence interval (CI): 0.50–0.71] compard with the non-CHP group. Those who used CHP for > 180 days had an even lower risk of CAD than users with CHP usage less than 30 days (aHR: 0.64, 95% CI: 0.43–0.95). Additionally, frequently prescribed formulae, such as Kuei-Chih-Shao-Yao-Chih-Mu-Tang, Tang-Kuei-Nien-Tung-Tang, and Shu-Ching-Huo-Hsieh-Tang, were associated with a reduced risk of CAD.ConclusionThe use of CHP was associated with a lower risk of CAD in patients with RA. Additional randomized controlled trials are required to assess any causal relationship between the effect of CHP usage and the risk of CAD.
Highlights
Few studies have evaluated the association between the risk of coronary artery disease (CAD) and the use of Chinese herbal products (CHP) in patients with rheumatoid arthritis (RA)
Regarding in the aspect of comorbidities, the proportion of hypertension was significantly lower in the CHP group than in the non-CHP group but, by contrast, the proportion of COPD was higher in the CHP group than in the non-CHP group
A total of 568 CAD cases were identified during the follow-up period, with an incidence rate of CAD of 8.06 per 1000 person-years in the CHP group and 14.93 per
Summary
Few studies have evaluated the association between the risk of coronary artery disease (CAD) and the use of Chinese herbal products (CHP) in patients with rheumatoid arthritis (RA). The release of IL-6 and TNF-α is stimulated by chronic systemic inflammation, and these proinflammatory cytokines which increase vascular calcification and accelerate atherosclerosis progression, from early atheroma formation to thrombus development, may play a primary role in increasing the risk of CAD in patients with RA [5,6,7]. The conventional treatment for RA includes nonsteroidal anti-inflammatory drugs (NSAIDs), corticosteroids, disease-modifying antirheumatic drugs (DMARDs), and TNF antagonists. These commonly used drugs have an anti-inflammatory mechanism. Patients have tended to seek CAM for pain relief or symptom management in recent times [13]
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