Rheumatoid arthritis (RA) is associated with an increased risk of ischemic heart disease, both in early and established disease. Data on the risk of ischemic heart disease in relation to therapy with TNF antagonists in established RA are conflicting, and are essentially lacking in early RA. In established RA, the risk of a myocardial infarction has been linked with the response to anti-TNF-alpha therapies (anti-TNF).
Objectives: To study the risk of acute coronary syndromes (ACS) in patients with early RA in relation to treatment with, and response to, anti-TNF.
Methods: A cohort consisting of patients with RA diagnosed 1999-2007 was identified from the Swedish RA Register (n=6,000) from which information on disease activity, and pharmacological treatment was extracted. The risk of first ACS among patients treated with anti-TNF or not was compared using hazard ratios (HR). In a nested case-control study, the relationship between response to anti-TNF and the risk for an ACS was investigated.
Results: In the cohort study, anti-TNF was not related to any statistically significantly altered risk of ACS, HR 0.80 (0.52-1.24). In the nested case-control study, a good or moderate EULAR response at 3 or 6 months was not associated with a risk of ACS, OR 1.7 (0.5-5.1) and 1.5 (0.3-6.9), respectively, when adjusted for disease activity before treatment start.
Conclusion: In this study of patients treated with anti-TNF therapy within the first years of RA disease, neither treatment with, nor response to, anti-TNF therapy could be linked to any statistically significant decrease in ACS risk.
2012. Vol. 64, no 1, 42-52 p.