Drugs Used in the Treatment of Rheumatoid Arthritis: Relationship between Current Use and Cardiovascular Risk Factors.
OBJECTIVES: Drugs used for the treatment of rheumatoid arthritis (RA) have the potential to affect cardiovascular risk factors. There is concern that corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors could affect cardiovascular risk adversely, while drugs such as the antimalarial, hydroxychloroquine, may have beneficial effects. However, there is limited information about cardiovascular risk factors in patients with RA receiving different drugs. METHODS: We measured cardiovascular risk factors including systolic and diastolic blood pressure, serum HDL and LDL cholesterol, glucose and homocysteine concentrations and urinary F(2)-isoprostane excretion in 169 patients with RA. Risk factors were compared according to current use of corticosteroids, methotrexate, antimalarials, NSAIDs, COX-2 inhibitors, leflunomide and TNF-alpha blockers. Comparisons were adjusted for age, sex, race, disease activity (DAS28 score), current hypertension, diabetes, smoking status and statin use. RESULTS: No cardiovascular risk factor differed significantly among current users and non-users of NSAIDs, COX-2 inhibitors, methotrexate and TNF-alpha blockers. Serum HDL cholesterol concentrations were significantly higher in patients currently receiving corticosteroids (42.2 +/- 10.5 vs. 50.2 +/- 15.3 mg/dL, adjusted P < 0.001). Diastolic blood pressure (75.9 +/- 11.2 vs. 72.0 +/- 9.1 mm Hg, adjusted P = 0.02), serum LDL cholesterol (115.6 +/- 34.7 vs. 103.7 +/- 27.8 mg/dL, adjusted P = 0.03) and triglyceride concentrations (157.7 +/- 202.6 vs. 105.5 +/- 50.5 mg/dL, adjusted P = 0.03) were significantly lower in patients taking antimalarial drugs. Plasma glucose was significantly lower in current lefunomide users (93.0 +/- 19.2 vs. 83.6 +/- 13.4 mg/dL, adjusted P = 0.006). CONCLUSIONS: In a cross-sectional setting drugs used to treat RA did not have major adverse effects on cardiovascular risk factors and use of antimalarials was associated with beneficial lipid profiles.
Rho
Young Hee
YH
Divisions of Clinical Pharmacology and Rheumatology, Vanderbilt University School of Medicine Nashville, TN, USA.
Oeser
Annette
A
Chung
Cecilia P
CP
Milne
Ginger L
GL
Stein
C Michael
CM
Ren Fail. 1999 Mar;21(2):189-97
10088179
Arthritis Res Ther. 2006;8(6):R186
17169159
Am J Med. 1994 Mar;96(3):254-9
8154514
Arthritis Rheum. 2008 Sep;58(9):2662-9
18759301
J Rheumatol. 1986 Oct;13(5):841-5
3820193
Ann Rheum Dis. 2007 Nov;66(11):1503-7
17472994
Clin Physiol. 1993 Mar;13(2):209-16
8453873
J Clin Gastroenterol. 2001 Oct;33(4):289-94
11588541
Ann Rheum Dis. 2002 Jun;61(6):567-9
12006342
Arch Drug Inf. 2008 Jul;1(1):23-28
20157365
Nat Protoc. 2007;2(1):221-6
17401357
Rheumatology (Oxford). 2004 Mar;43(3):267-71
14963199
Drugs. 2002;62(4):605-16
11893229
N Engl J Med. 2007 Nov 22;357(21):2109-22
17984165
Can J Cardiol. 2000 Apr;16(4):505-11
10787466
Nature. 2006 Dec 14;444(7121):794-5
17167436
Curr Med Chem. 2007;14(6):703-17
17346157
N Engl J Med. 2006 Aug 31;355(9):873-84
16943400
Arthritis Res Ther. 2008;10(2):R30
18325087
Atherosclerosis. 2008 Feb;196(2):756-63
17266963
Ann Rheum Dis. 2007 Apr;66(4):558-9
17360784
Arthritis Rheum. 2005 Oct;52(10):3045-53
16200609
Arthritis Rheum. 1995 Jan;38(1):44-8
7818570
Arthritis Rheum. 2008 Jul;58(7):2105-12
18576352
Arthritis Rheum. 2001 May;44(5):1048-51
11352235
Lupus. 1996 Jun;5 Suppl 1:S16-22
8803905
N Engl J Med. 2005 Mar 17;352(11):1092-102
15713943
Lancet. 2002 Apr 6;359(9313):1173-7
11955534