The effect of pharmacological therapy on the cardiovascular system of patients with systemic rheumatic diseases.

Abstract

The higher mortality rate among rheumatoid arthritis (RA) patients in comparison with the general population is largely attributable to cardiovascular (CV) disease, particularly coronary atherosclerosis, but also non-fatal myocardial infarction and heart failure. It may be due to RA-specific risk factors such as hyperhomocysteinemia, disease-related dyslipidemia or vascular inflammation, or morbidity related to high levels of cytokines such as tumour necrosis factor (TNF) and RA medications. Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most important in rheumatology, but many are associated with CV disease. A number of randomised control trials have shown that, although exposure to low doses of corticosteroids for 1-3years does not significantly increase CV risk, longer exposure can increase CV events. The use of disease-modifying antirheumatic drugs (DMARDs), particularly methotrexate, increases homocysteinemia, reduces inflammation and improves lipid profiles, thus reducing the development of atherosclerosis and clinically overt CVD. Although contraindicated in RA patients with severe heart failure, biological agents such as anti-TNF agents delay and even reverse the progression of endothelial dysfunction and atherosclerosis. Tocilizumab leads to changes in lipid profiles without increasing adverse vascular events. The effects on the CV system depend on the drug itself, the dose and the period of exposure, and so CV risk should be evaluated before starting treatment with any drug.

• Authors: Fabiola Atzeni, Maurizio Turiel, Roberto Caporali, Lorenzo Cavagna, Livio Tomasoni, Simona Sitia, Piercarlo Sarzi-Puttini
• Journal: Autoimmunity reviews (Autoimmun Rev) Vol. 9 Issue 12 Pg. 835-9 (Oct 2010) ISSN: 1873-0183 [Electronic] Netherlands
• PMID: 20678592 (Publication Type: Journal Article)
• Copyright: Copyright © 2010 Elsevier B.V. All rights reserved.

Chemical References

• Anti-Inflammatory Agents, Non-Steroidal
• Antibodies, Monoclonal
• Antibodies, Monoclonal, Humanized
• Antirheumatic Agents
• Infliximab
• tocilizumab

Topics

• Anti-Inflammatory Agents, Non-Steroidal (adverse effects, therapeutic use)
• Antibodies, Monoclonal (therapeutic use)
• Antibodies, Monoclonal, Humanized
• Antirheumatic Agents (therapeutic use)
• Arthritis, Rheumatoid (drug therapy, epidemiology, immunology, physiopathology)
• Clinical Trials as Topic
• Coronary Artery Disease (drug therapy, epidemiology, immunology, physiopathology)
• Endothelium, Vascular (immunology)
• Humans
• Inflammation
• Infliximab