Risk of Cardiovascular Diseases

Patients with rheumatoid arthritis (RA) are at higher risk to develop cardiovascular diseases than the general population. Today, chronic inflammation characterizing RA is suggested to encourage development of atherosclerosis, myocardial infarction, heart failure and stroke.

Tumor necrosis factor alpha (TNF-a) is a central messenger of the rheumatic inflammation. Moreover, it is well known today that TNF-a plays a key role in the development and progression of atherosclerosis and in the worsening of heart failure. Biologic DMARDs inhibiting messengers of the rheumatic inflammatory cascade may reduce not only the inflammatory activity but also the risk of heart failure.

In RABBIT, we investigated the incidence of heart failure in RA patients with and without common risk factors for cardiovascular diseases; secondly, we examined the rate of deterioration of heart failure in patients with pre-existing heart failure. Patients treated with biologic DMARDs were compared with patients receiving non-biologic DMARDs, respectively. The incidence throughout the three-year observation period was different in patients with (2.2 %) and without general risk factors for cardiovascular diseases (0.7 %); deterioration of pre-existing heart failure occurred in 12.5 % of the respective patients. High disease activity of RA was found as the independent main influencing factor. Accordingly, patients with active rheumatic inflammation appear to have a particularly high risk of incident or progressive heart failure. Consequential control of rheumatic inflammation inhibits not only (late) sequelae of RA such as deformation and stiffening of joints, but may also diminish the risk of concomitant cardiovascular diseases. The choice of either biologic or non-biologic DMARDs as treatment is probably of minor importance, but it is vital that the disease activity is controlled (Listing et al. Arthritis Rheumat. 2008; 58 (3): 667 – 677).