ACR/ARHP 2013 Report – Anti-TNF therapy lowers risk of acute coronary syndrome in rheumatoid arthritis

by Bruce Sylvester – Anti-TNF treatment reduces risk of acute coronary syndrome, like heart attacks and angina, in rheumatoid arthritis patients, researchers reported at the American College of Rheumatology 2013 Annual Meeting.

“As modern therapeutic alternatives in RA often make it possible to achieve a good control of joint inflammation, it is important to evaluate if this can also affect comorbidities. Patients with RA have a doubled or so risk for acute coronary syndrome, and cardiovascular prevention is thus a major task for rheumatologists,” said lead investigator Lotta Ljung, MD, senior consultant in rheumatology at  Umea University Hospital  in Umea, Sweden.

The researchers evaluated data on coronary heart disease among RA patients using TNF inhibitors,  compared to RA patients not using the drugs, and  to  the general population.

They identified a cohort of 7,704 RA patients from the Swedish Biologics Register with no previous incidence of ischemic heart disease who initiated TNF inhibitor therapy between 2001 and 2010. Subjects were 75.9 percent female and an average age of 57.1 years-old.

A comparator cohort of 23,112 matched subjects with RA who had never taken a biologic were identified from the (Swedish) National Patient Register.  A second comparator group of 38,520 matched subjects were randomly selected from the general population register.

The investigators evaluated data according to three periods of exposure to TNF inhibitors:

• “Actively” was defined as taking a TNF inhibitor until date of termination plus 90 days.
• “Short-term exposure” was defined as taking TNF inhibitors for up to two years.
• “Ever” was defined as having ever taking a TNF inhibitor.

They defined acute coronary syndrome as any primary discharge diagnosis of heart attack, unstable angina, or heart attack as cause of death from the Patient Register and from the Cause-of-Death Register, respectively.

The researchers reported that ACS appeared in the general population at a rate of 3.3/1,000 person-years, compared to 5.7 /1,000 person-years among those patients with RA actively on TNF inhibitor treatment and 8.6/1,000 person- years among those with RA who had never had TNF inhibitor treatment.

Compared to RA subjects who have never had TNF inhibitor treatment, the risk of ACS among subjects actively using a TNF inhibitor was 27 percent lower.

“This nationwide study adds to the evidence that use of TNF inhibitors for RA also has an impact on cardiovascular comorbidity,” Dr. Ljung said. “Whether the lowered risk of ACS is attributable to the TNF inhibitors as such, or is an effect of better inflammatory control, cannot be determined from this study. The increase in risk of ACS in patients with RA was lower, but not abolished by the treatment. Therefore, individualized cardiovascular prevention is needed for most patients.”