9/13/11 A new Swedish study has found that treatment with tumor necrosis factor-alpha inhibitors, or anti-TNFs, does not lower the risk of heart attacks and unstable angina – a type of chest pain that may lead to a heart attack – in patients with early rheumatoid arthritis.
It’s well known that rheumatoid arthritis, or RA, increases the risk of cardiovascular disease, but it is unclear whether anti-TNFs reduce that risk. TNF inhibitors – adalimumab, or Humira; etanercept, or Enbrel; infliximab, or Remicade; certolizumab pegol, or Cimzia; and golimumab, or Simponi – are biologic medications that block a cytokine linked to inflammation. Chronic inflammation is believed to play a large role in cardiovascular disease.
Previous studies on these drugs’ effects on cardiovascular risk show mixed results. Several studies have shown that anti-TNFs do lower the risk of cardiovascular disease in patients with established RA. But the new study, published online in Arthritis & Rheumatism, shows that benefit doesn’t extend to early RA patients – at least not in the specific category of acute coronary syndromes, or ACS, which includes heart attacks and unstable angina.
“I would not hesitate to treat the inflammatory disease with an anti-TNF when it is indicated, but, as a rheumatologist, I must be aware that this alone might not be enough to normalize the risk for myocardial infarction [heart attack] for my patient,” explains lead author Lotta Ljung, MD, a senior consultant in rheumatology at Umeå University Hospital in Umeå, Sweden.
For this latest study, Dr. Ljung and colleagues identified 6,000 patients from a national Swedish database who were treated within a year of developing RA symptoms. Within this group, they found 173 first-time ACS events. They then calculated the risks of heart attack or unstable angina for those taking and not taking anti-TNFs. Ultimately they didn’t find any statistically significant differences in risk between the two groups.
After performing a second analysis, the researchers also failed to find a difference in risk for ACS between those patients who had responded to anti-TNF therapy and those who had not respond.
Dr. Ljung says her team’s findings could be different from earlier studies showing a protective effect of anti-TNFs on the heart because of different patient populations and the fact that previous research is based on a broader definition of cardiovascular risk than her team used.
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