Department of Rheumatology Institute of Medicine, University of Debrecen Medical and Health Science Center, Debrecen, Hungary.
Nat Rev Rheumatol. 2009 Dec;5(12):677-84. doi: 10.1038/nrrheum.2009.219. Epub 2009 Nov 10.
Endothelial dysfunction and accelerated atherosclerosis lead to increased cardiovascular morbidity and mortality in patients with rheumatoid arthritis and other inflammatory rheumatic diseases. Sustained inflammation is a major risk factor for cardiovascular disease. Apart from traditional vasculoprotective agents, biologic agents may also exert favorable effects on the vasculature. Indeed, agents that inhibit tumor necrosis factor (TNF) seem to transiently improve endothelial function. Data regarding the effects of biologic agents on atherosclerosis and arterial stiffness are inconsistent. The effects of the various TNF blockers on dyslipidemia might differ: long-term infliximab therapy could be pro-atherogenic, whereas some studies suggest that etanercept and adalimumab may exert beneficial effects on the lipid profile. TNF blockers have been shown to decrease the incidence of cardiovascular events in patients with rheumatoid arthritis. Preliminary data suggest that rituximab also improves endothelial function and dyslipidemia. Further studies are needed to determine the net effects of biologic agents on the vasculature.
内皮功能障碍和动脉粥样硬化加速导致类风湿关节炎和其他炎症性风湿病患者心血管发病率和死亡率增加。持续的炎症是心血管疾病的一个主要危险因素。除了传统的血管保护剂外，生物制剂也可能对血管发挥有利的作用。事实上，抑制肿瘤坏死因子 (TNF) 的药物似乎能短暂改善内皮功能。关于生物制剂对动脉粥样硬化和动脉僵硬的影响的数据并不一致。各种 TNF 阻滞剂对血脂异常的影响可能不同：长期使用英夫利昔单抗治疗可能具有致动脉粥样硬化作用，而一些研究表明依那西普和阿达木单抗可能对血脂谱有有益的影响。TNF 阻滞剂已被证明可降低类风湿关节炎患者心血管事件的发生率。初步数据表明利妥昔单抗也能改善内皮功能和血脂异常。需要进一步的研究来确定生物制剂对血管的净效应。
