Rheumatoid Arthritis Drugs May Cut Cardiovascular Risk

“Prior observational studies did not adjust for inflammatory burden, lipid profiles, or blood pressure,” Dr. Bili said; her study adjusted for these factors.

Prevalent CVD excluded 163 patients from the study. Use of methotrexate or TNF-α inhibitors, the researchers found, was independently associated with a reduction in incident CVD compared with patients who never used the medication. Patients receiving methotrexate therapy longer than 22 months had a 72% reduction in CVD, the authors calculate.

The CVD risk decreased further with prolonged drug exposure, according to Dr. Bili. The investigators reportedly observed a similar CVD reduction of 69% after more than 17 months of treatment with TNF-α inhibitors.

“Our results suggest these medications may be protective against cardiovascular disease in a group of patients who are at risk of cardiovascular disease,” she said.

However, observational studies cannot prove causation, Dr. Bili added. Given the homogeneous population (95% white, 73% female), she also cautioned against extrapolating the data to other populations.

Replying to a question from the audience, the presenter said they lacked sufficient power to break down results by specific TNF-α inhibitor.

Scleroderma

Most scleroderma experts agree that echocardiograms and pulmonary function tests should be performed annually in scleroderma patients to screen for pulmonary hypertension, said Ami A. Shah, MD, MHS, assistant professor of medicine at Johns Hopkins Scleroderma Center in Baltimore.

“However, prior data suggest that echocardiography screening is not used routinely in community rheumatology practices, even if patients are symptomatic with shortness of breath,” Dr. Shah said.

Prior study data suggest that right ventricular (RV) systolic pressure on an echocardiogram correlates only moderately with mean pulmonary artery pressure on right-sided heart catheterization.¹ Because the value of echocardiography in screening for pulmonary hypertension is unclear, Dr. Shah and her colleagues performed a retrospective study of patients with scleroderma who had at least three echocardiograms in one year (abstract 720).

From data collected since 1990 at the researchers’ tertiary care center, 685 patients met inclusion criteria. The investigators compared the change in RV systolic pressure on 3,541 echocardiograms obtained at various clinical sites, and tracked patients’ deaths using the Social Security Death Index. Nearly 15% of patients had pulmonary arterial hypertension (PAH) confirmed by cardiac catheterization, the authors reported. Almost 27% of patients died over the eight-year mean follow-up (median survival was 11 years).