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Rheumatoid Arthritis Drugs May Lower Heart Attack, Stroke Risk

THURSDAY, March 6 -- People taking medications for rheumatoid arthritis may also be reducing their risk of heart attack and stroke, a new study suggests.

People with rheumatoid arthritis (RA), which causes pain, swelling, stiffness and loss of function in the joints, face a greater risk of cardiovascular disease, because it can lead to hardening of the arteries. Heart attack and stroke can occur 10 years earlier than in people without the condition, the researchers said.

By taking medications that reduce the inflammation caused by rheumatoid arthritis, the risk of heart attack and stroke may be significantly reduced, the study authors said.

"Our study demonstrated that the time of exposure both to disease-modifying anti-rheumatic drugs and biological agents is associated with a reduction of the risk of cardiovascular events," said lead researcher Dr. Antonio Naranjo, of the Universidad de Las Palmas de Gran Canaria, in Spain.

Those drugs include common RA medications such as methotrexate, sulfasalazine, glucocorticoids, leflunomide and biological agents such as TNF-alpha blockers, the researchers noted.

Naranjo said doctors know that by controlling the chronic inflammation caused by rheumatoid arthritis, it's possible to reduce cardiovascular risk. "The practical consequence of our work is that in patients with RA, especially in the most severe cases, both the classic cardiovascular risk factors and the inflammatory activity of the disease need to be controlled," he said.

For the study, Naranjo's team analyzed data on 4,363 patients who took part in the Quantitative Patient Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis study. The researchers found that taking drugs such as methotrexate lowered the risk of a heart attack or stroke. For example, RA patients taking methotrexate for one year can reduce their risk of heart attack by 18 percent and stroke by 11 percent, the investigators reported.

"Methotrexate, other disease-modifying anti-rheumatic drugs and biologic agents could reduce the extra risk of myocardial infarction [heart attack] and stroke that patients with rheumatoid arthritis have by controlling inflammation," Naranjo said.

The findings were published in the March 5 issue of Arthritis Research & Therapy.

One heart expert thinks this retrospective study is intriguing, but it didn't really determine if the medications for controlling inflammation actually lowered the risk of heart attack and stroke.

"While certain associations are shown between the use of anti-inflammatory agents and prior cardiovascular events in patients with rheumatoid arthritis, a cause-and-effect relationship cannot be demonstrated in this type of study," said Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles.

Prospective data and, ultimately, prospective randomized clinical trials are needed before any firm conclusions can be drawn about whether these drugs really lower the risk of heart attack and stroke, he said.

More information

To learn more about rheumatoid arthritis, visit the U.S. National Library of Medicine.

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Posted: March 2008