Rho Young Hee, Oeser Annette, Chung Cecilia P, Milne Ginger L, Stein C Michael
Divisions of Clinical Pharmacology and Rheumatology, Vanderbilt University School of Medicine Nashville, TN, USA.
Arch Drug Inf. 2009 Jun;2(2):34-40. doi: 10.1111/j.1753-5174.2009.00019.x.
Drugs used for the treatment of rheumatoid arthritis (RA) have the potential to affect cardiovascular risk factors. There is concern that corticosteroids, non-steroidal anti-inflammatory drugs (NSAIDs) and COX-2 inhibitors could affect cardiovascular risk adversely, while drugs such as the antimalarial, hydroxychloroquine, may have beneficial effects. However, there is limited information about cardiovascular risk factors in patients with RA receiving different drugs. METHODS: We measured cardiovascular risk factors including systolic and diastolic blood pressure, serum HDL and LDL cholesterol, glucose and homocysteine concentrations and urinary F(2)-isoprostane excretion in 169 patients with RA. Risk factors were compared according to current use of corticosteroids, methotrexate, antimalarials, NSAIDs, COX-2 inhibitors, leflunomide and TNF-alpha blockers. Comparisons were adjusted for age, sex, race, disease activity (DAS28 score), current hypertension, diabetes, smoking status and statin use. RESULTS: No cardiovascular risk factor differed significantly among current users and non-users of NSAIDs, COX-2 inhibitors, methotrexate and TNF-alpha blockers. Serum HDL cholesterol concentrations were significantly higher in patients currently receiving corticosteroids (42.2 +/- 10.5 vs. 50.2 +/- 15.3 mg/dL, adjusted P < 0.001). Diastolic blood pressure (75.9 +/- 11.2 vs. 72.0 +/- 9.1 mm Hg, adjusted P = 0.02), serum LDL cholesterol (115.6 +/- 34.7 vs. 103.7 +/- 27.8 mg/dL, adjusted P = 0.03) and triglyceride concentrations (157.7 +/- 202.6 vs. 105.5 +/- 50.5 mg/dL, adjusted P = 0.03) were significantly lower in patients taking antimalarial drugs. Plasma glucose was significantly lower in current lefunomide users (93.0 +/- 19.2 vs. 83.6 +/- 13.4 mg/dL, adjusted P = 0.006). CONCLUSIONS: In a cross-sectional setting drugs used to treat RA did not have major adverse effects on cardiovascular risk factors and use of antimalarials was associated with beneficial lipid profiles.
用于治疗类风湿关节炎（RA）的药物有可能影响心血管危险因素。人们担心皮质类固醇、非甾体抗炎药（NSAIDs）和COX-2抑制剂可能对心血管风险产生不利影响，而抗疟药羟氯喹等药物可能具有有益作用。然而，关于接受不同药物治疗的RA患者心血管危险因素的信息有限。方法：我们测量了169例RA患者的心血管危险因素，包括收缩压和舒张压、血清高密度脂蛋白（HDL）和低密度脂蛋白（LDL）胆固醇、血糖和同型半胱氨酸浓度以及尿F(2)-异前列腺素排泄量。根据目前是否使用皮质类固醇、甲氨蝶呤、抗疟药、NSAIDs、COX-2抑制剂、来氟米特和肿瘤坏死因子-α（TNF-α）阻滞剂对危险因素进行比较。比较时对年龄、性别、种族、疾病活动度（DAS28评分）、目前是否患有高血压、糖尿病、吸烟状况和他汀类药物使用情况进行了校正。结果：目前使用NSAIDs、COX-2抑制剂、甲氨蝶呤和TNF-α阻滞剂的患者与未使用者之间，没有任何心血管危险因素存在显著差异。目前接受皮质类固醇治疗的患者血清HDL胆固醇浓度显著更高（42.2±10.5对50.2±15.3mg/dL，校正P<0.001）。服用抗疟药的患者舒张压（75.9±11.2对72.0±9.1mmHg，校正P=0.02）、血清LDL胆固醇（115.6±34.7对103.7±27.8mg/dL，校正P=0.03）和甘油三酯浓度（157.7±202.6对105.5±50.5mg/dL，校正P=0.03）显著更低。目前使用来氟米特的患者血浆葡萄糖显著更低（93.0±19.2对83.6±13.4mg/dL，校正P=0.006）。结论：在横断面研究中，用于治疗RA的药物对心血管危险因素没有重大不利影响，且使用抗疟药与有益的血脂谱相关。
