Systematic review and meta‐analysis: Anti–tumor necrosis factor α therapy and cardiovascular events in rheumatoid arthritis

Abstract

Objective. Control of rheumatoid arthritis (RA) may reduce the risk of cardiovascular events. We sought to systematically assess the association between anti-tumor necrosis factor ␣ (anti-TNF␣) therapy in RA and cardiovascular event rates. Conclusion. Anti-TNF␣ therapy is associated with a reduced risk of all cardiovascular events, MI, and CVA in observational cohorts. There was heterogeneity among cohort studies and possible publication bias. The point estimate of the effect from RCTs is underpowered with wide 95% CIs, and cardiovascular events were secondary outcomes, but RCTs also demonstrated a trend toward decreased risk.

Modulation of Autoimmunity and Atherosclerosis – Common Targets and Promising Translational Approaches Against Disease –

“…Anti-TNF therapy is associated with a general reduction of inflammation; improved inflammatory parameters, such as C-reactive protein (CRP); and improved endothelial function. 37 Notably, increased TNF levels in plasma correlated with insulin resistance and greater plasma glucose prior to the onset of type 2 diabetes, 43 suggesting that the blockade of TNF, which is also secreted by fat cells within muscles, liver, and adipose tissue, has other cardioprotective effects. Consistent with this hypothesis, RA and Crohn disease patients who have concomitant type 2 diabetes and are treated with anti-TNF experience significant improvements in their fasting glucose values.…”

Lipid Profile in Rheumatoid Arthritis and its Relation with Inflammatory Markers

“…This lipid increase is not associated with a rise in the number of CV events in these patients. Contrary to this, probably due to the anti-inflammatory effect, conventional disease-modifying anti-rheumatic drugs, such as methotrexate, and different biological agents have demonstrated a reduction of the CV death rate in patients with RA [8][9][10][11]. The reduction in the rate of CV events seems to be directly related to better control of the rheumatic disease.…”

Effects of TNF-α Inhibitors on Abdominal Adiposity in Patients with Inflammatory Rheumatic Diseases

“…But a number of studies have described changes in lipid profile under anti-TNF treatment, with an increase in both total and low-density lipoprotein cholesterol 8 . However, there is substantial evidence indicating that the longterm CV risk is improved during anti-TNF treatment in patients with RA 9 . Various changes in adipokine serum levels have also been reported during anti-TNF therapy and no definite conclusion can be drawn regarding these variables and their effect on metabolic balance and thus on CV risk 2,10 .…”