Back to Search
Start Over
Biological use influences the impact of inflammation on risk of major adverse cardiovascular events in rheumatoid arthritis.
- Source :
-
RMD open [RMD Open] 2024 Jul 23; Vol. 10 (3). Date of Electronic Publication: 2024 Jul 23. - Publication Year :
- 2024
-
Abstract
- Objectives: Chronic inflammation promotes cardiovascular risk in rheumatoid arthritis (RA). Biological disease-modifying antirheumatic drugs (bDMARDs) improve disease activity and cardiovascular disease outcomes. We explored whether bDMARDs influence the impact of disease activity and inflammatory markers on long-term cardiovascular risk in RA.<br />Methods: We studied 4370 participants without cardiovascular disease in a 10-country observational cohort of patients with RA. Endpoints were (1) major adverse cardiovascular events (MACE) encompassing myocardial infarction, stroke and cardiovascular death; and (2) any ischaemic cardiovascular events (iCVE) including MACE plus revascularisation, angina, transient ischaemic attack and peripheral arterial disease.<br />Results: Over 26 534 patient-years, 239 MACE and 362 iCVE occurred. The interaction between 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) and bDMARD use was significant for MACE (p=0.017), suggesting the effect of DAS28-CRP on MACE risk differed among bDMARD users (n=515) and non-users (n=3855). DAS28-CRP (per unit increase) is associated with MACE risk in bDMARD non-users (HR 1.21 (95% CI 1.07 to 1.37)) but not users (HR 0.69 (95% CI 0.40 to 1.20)). The interaction between CRP (per log unit increase) and bDMARD use was also significant for MACE (p=0.011). CRP associated with MACE risk in bDMARD non-users (HR 1.16 (95% CI 1.04 to 1.30)), but not users (HR 0.65 (95% CI 0.36 to 1.17)). No interaction was observed between bDMARD use and DAS28-CRP (p=0.167) or CRP (p=0.237) for iCVE risk.<br />Conclusions: RA activity and inflammatory markers associated with risk of MACE in bDMARD non-users but not users suggesting the possibility of biological-specific benefits locally on arterial wall independently of effects on systemic inflammation.<br />Competing Interests: Competing interests: None declared.<br /> (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Subjects :
- Humans
Male
Female
Middle Aged
Aged
Biomarkers
C-Reactive Protein metabolism
C-Reactive Protein analysis
Risk Factors
Severity of Illness Index
Arthritis, Rheumatoid complications
Arthritis, Rheumatoid drug therapy
Antirheumatic Agents therapeutic use
Antirheumatic Agents adverse effects
Cardiovascular Diseases etiology
Cardiovascular Diseases epidemiology
Cardiovascular Diseases mortality
Inflammation
Subjects
Details
- Language :
- English
- ISSN :
- 2056-5933
- Volume :
- 10
- Issue :
- 3
- Database :
- MEDLINE
- Journal :
- RMD open
- Publication Type :
- Academic Journal
- Accession number :
- 39043615
- Full Text :
- https://doi.org/10.1136/rmdopen-2024-004546