TNF-α inhibitors may help reduce cardiovascular risk in RA

Tumor necrosis factor α (TNF-α) inhibitor treatment for patients who have rheumatoid arthritis (RA) probably will reduce, not increase, the risk of heart failure if it effectively reduces inflammatory activity. TNF-α inhibition also might not increase the risk of worsening of prevalent heart failure.

Listing and associates studied 2757 patients and 1491 controls who started treatment with a TNF-α inhibitor or a conventional disease-modifying antirheumatic drug, respectively. Assessments included a functional status questionnaire and the 28-joint Disease Activity Score (DAS28).

The 3-year incidence of heart failure was 2.2% in patients who had cardiovascular disease at the start of treatment compared with 0.4% in patients who did not. In de novo cases of heart failure, an increase of 1 unit or 2 units in the DAS28 score resulted in a 1.4-fold or 1.8-fold increase in risk, respectively. After adjustment for traditional risk factors, no significant results were found for the hazard ratios (HRs) of treatment with TNF-α inhibitors; an HR of 0.70 was calculated for the combined positive and negative effects of TNF-α inhibitors.

The authors noted that screening of patients who have severe RA for cardiac risk factors and effective management of both the RA and the cardiac disease are essential.