title: Effects of TNFα inhibitors on adiposity and other cardiovascular risk factors: implications for the cardiovascular prognosis in patients with rheumatoid arthritis.
abstract: BACKGROUND
  Rheumatoid arthritis (RA) is a chronic inflammatory disease that is associated with increased cardiovascular (CV) morbidity and mortality. This increased CV burden is the result of an enhanced prevalence of traditional CV risk factors, the effects of treatments given for RA but also systemic inflammation. In this setting, the control of inflammation by the current therapeutic approach may improve the overall CV prognosis of RA.
  
  
  METHODS
  This paper analyses the impact of TNFα inhibitors on the different CV risk factors with a special emphasis on lipid profile and body composition. The lipid profile under TNFα inhibitors changes, an increase in total and high density lipoprotein (HDL) cholesterol is observed but the atherogenic index and low density lioprotein cholesterol are unaffected. In parallel, TNFα inhibitors induce an accumulation of fat in the abdominal/visceral region. Analysis of cohort and registry studies indicates that CV events are reduced under this treatment.
  
  
  CONCLUSIONS
  Overall, the favourable CV effect under TNFα inhibitors does not seem to be explained by the changes in traditional CV risk factors, but rather by the improvement in systemic inflammation. Alternatively, the changes in body composition raise the question of their effect on long-term CV safety.
authors.affiliation: Professor, University Hospital of Besançon, Clinical Investigation Centre for Biotherapy INSERM CIC-1431, FHU INCREASE , Place St Jacques, 25000 Besançon , France +33 3 81 21 89 97 ; +33 3 81 21 85 22 ; etoussirot@chu-besancon.fr.
authors.forename: Éric
authors.initials: É
authors.lastname: Toussirot
mesh_terms: D050154:Adiposity / Q000187:drug effects; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D001823:Body Composition / Q000187:drug effects; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007249:Inflammation / Q000188:drug therapy; D008055:Lipids / Q000097:blood; D011379:Prognosis; D012307:Risk Factors; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors*
chemical_list: D018501:Antirheumatic Agents; D008055:Lipids; D014409:Tumor Necrosis Factor-alpha
keywords: adiposity; atherogenic index; cardiovascular risk factors; lipids