The risk of heart attack associated with rheumatoid arthritis (RA) may decrease by nearly half when TNF inhibitors (TNFi) are part of the treatment, according to new research conducted at the University of Manchester, United Kingdom.
Patients with RA have a 60% higher risk of heart attacks than the general public. The higher risk is believed to be related to joint inflammation, which leads to the development of blood vessel anomalies (that then can affect blood flow). Current available treatments to reduce inflammation associated with RA include TNFi drugs, which work by decreasing the activity of inflammatory proteins, and synthetic disease-modifying therapies (sDMARDs), such as methotrexate, which delay disease progression.
In the U.K., doctors are allowed to prescribe TNFi drugs to patients with signs of chronic and highly active RA, and for whom treatment with sDMARDS was inefficient, but not to patients with moderate levels of the disease.
Researchers followed RA patients on TNFi medication (11,200 patients) and on sDMARDs (3,058 patients), and analyzed medical data from their clinical follow-up recorder over three to five years to investigate the risk of heart attack and severity of attack (when it occurred).
The analysis indicated that the risk of heart attack was reduced by nearly 40% in patients who had been on TNFi therapy compared to patients on sDMARD therapy only.
“Our team has been able to show that this elevated risk can be reduced significantly by using biological drug therapies such as TNFi”, said Kimme Hyrich, MD, PhD, senior author of the study, in a press release. “The prescribing guidelines for TFNi therapies are very specific, and for good reason.”
“However, the biologically plausible explanation for our findings – not only that TFNi reduces the inflammation associated with atherosclerosis, but that it also may inhibit the accumulation and progression of plaque leading to fewer heart attacks – could be used to review existing guidelines and, in particular, extend the use to patients with moderate levels of disease activity.”
Results also indicated that, among RA patients who had a heart attack while receiving treatment, the severity of the attack was not associated with either therapy.
Overall, the study showed that none of the two types of drugs analyzed influenced the severity (or survival) of heart attacks in RA patients, but TNFi therapies may reduce the risk of having one. Further studies are warranted to confirm these results and study exactly how these drugs may exert their protective effect.
“This study, which linked the national registry of patients with rheumatoid arthritis with the national health attack registry, shows a striking relationship between the use of biological treatments for rheumatoid arthritis and reduced risk of heart attack”, said Chris Gale, PhD, another study author. “Clearly, further research is needed to investigate the cellular mechanisms behind this, but also to test whether immunosuppressive agents may reduce the risk of heart attack in other high risk populations.”
Mike Knapton, MD, associate medical director at the British Heart Foundation, concluded “This research will inform future work, as we discover new ways to reduce heart attacks in people living with rheumatoid arthritis. In the meantime it is important that patients with rheumatoid arthritis should not only be offered treatment for their condition, but also offered management to reduce their risk of a heart attack – including managing blood pressure, cholesterol and lifestyle factors such as diet and exercise.”