Rheumatoid Arthritis: Heart Disease and Biologics

MedicalResearch.com Interview with:
Lotta Ljung, MD, PhD
Umeå University, Umeå and Karolinska  Institute
Stockholm, Sweden

MedicalResearch.com: What are the main findings of the study?

Dr. Ljung:  In this observational study we observed a lower risk of acute coronary syndromes in a cohort of patients with rheumatoid arthritis (RA) exposed to tumor necrosis factor inhibitors (TNFi) compared with the risk among patients without this exposure. The adjusted relative risk (HR) was 0.73-0.82  among TNFi exposed patients compared with the biologics-naive RA cohort, depending on the time frame evaluated, which can be concluded as a moderately lower risk.

Compared with the risk in the general population, the risk in RA patients was higher, whether exposed to TNFi or not.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Ljung: A number of previous studies have shown an increased risk of cardiovascular events, especially ischemic heart disease, among  patients with RA. Treatment that lower the inflammatory activity, such as methotrexate, has often been associated with lower cardiovascular risk. Regarding treatment with TNFi, previous studies have shown conflicting results and there has been a need for more evidence. This study supports the hypothesis of the inflammation in RA having an impact on the cardiovascular risk. It also adds to the evidence that treatment with TNFi is safe regarding the development of ischemic heart disease. The size of the study and its population based, nation-wide setting implicates a high probabililty of the results being generalizable to other populations.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Ljung: That treatment with TNFi are safe regarding the development of acute coronary syndrome in patients with RA, and that the treatment actually might lower the risk. As the over risk, compared with the risk in the general population, was not abolished, identification and management of traditional cardiovascular risk factors are needed for patients with RA also under treatment with TNFi.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Ljung: It would be valuable to evaluate if response to treatment is associated with the risk of cardiovascular disease in treated patients, if treatment is associated with a modified risk in specific subpopulations, and if there are any differences between the different TNFi drugs that are under use, as well as risk modifications for other cardiovascular outcomes. Studies on cardiovascular risk with other biological treatment options are also needed in the future.


Tumour Necrosis Factor Inhibitors and The Risk Of Acute Coronary Syndrome In Rheumatoid Arthritis – A National Cohort Study
Lotta Ljung, Umeå University, Umeå, Sweden

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Last Updated on October 29, 2013 by Marie Benz MD FAAD