University of Calgary, Calgary, Alberta, Canada.
Arthritis Care Res (Hoboken). 2011 Apr;63(4):522-9. doi: 10.1002/acr.20371.
Control of rheumatoid arthritis (RA) may reduce the risk of cardiovascular events. We sought to systematically assess the association between anti-tumor necrosis factor α (anti-TNFα) therapy in RA and cardiovascular event rates.
Observational cohorts and randomized controlled trials (RCTs) reporting on cardiovascular events (all events, myocardial infarction [MI], congestive heart failure, and cerebrovascular accident [CVA]) in RA patients treated with anti-TNFα therapy compared to traditional disease-modifying antirheumatic drugs were identified from a search of PubMed (1950 to November 2009), EMBase (1980 to November 2009), and conference abstracts. Relative risks (RRs) or hazard ratios and 95% confidence intervals (95% CIs) were extracted. If the incidence was reported, additional data were extracted to calculate an incidence density ratio and its variance.
The systematic review and meta-analysis include 16 and 11 publications, respectively. In cohort studies, anti-TNFα therapy was associated with a reduced risk for all cardiovascular events (pooled adjusted RR 0.46; 95% CI 0.28, 0.77), MI (pooled adjusted RR 0.81; 95% CI 0.68, 0.96), and CVA (pooled adjusted RR 0.69; 95% CI 0.53, 0.89). Meta-analysis of RCTs also produced a point estimate indicating lower risk of cardiovascular events, but this was not statistically significant (pooled RR 0.85; 95% CI 0.28, 2.59).
Anti-TNFα therapy is associated with a reduced risk of all cardiovascular events, MI, and CVA in observational cohorts. There was heterogeneity among cohort studies and possible publication bias. The point estimate of the effect from RCTs is underpowered with wide 95% CIs, and cardiovascular events were secondary outcomes, but RCTs also demonstrated a trend toward decreased risk.
类风湿关节炎（RA）的控制可能降低心血管事件的风险。我们旨在系统评估 RA 患者接受抗肿瘤坏死因子 α（anti-TNFα）治疗与心血管事件发生率之间的关系。
通过检索 PubMed（1950 年至 2009 年 11 月）、EMBase（1980 年至 2009 年 11 月）和会议摘要，确定了比较抗 TNFα 治疗与传统疾病修饰抗风湿药物治疗的 RA 患者心血管事件（所有事件、心肌梗死 [MI]、充血性心力衰竭和脑血管意外 [CVA]）的观察性队列研究和随机对照试验（RCT）。提取相对风险（RR）或风险比和 95%置信区间（95%CI）。如果报告了发生率，则提取额外数据以计算发生率密度比及其方差。
系统评价和荟萃分析分别纳入 16 项和 11 项研究。在队列研究中，抗 TNFα 治疗与所有心血管事件（合并调整 RR 0.46；95%CI 0.28，0.77）、MI（合并调整 RR 0.81；95%CI 0.68，0.96）和 CVA（合并调整 RR 0.69；95%CI 0.53，0.89）的风险降低相关。RCT 的荟萃分析也产生了一个表明心血管事件风险较低的点估计值，但没有统计学意义（合并 RR 0.85；95%CI 0.28，2.59）。
在观察性队列研究中，抗 TNFα 治疗与所有心血管事件、MI 和 CVA 的风险降低相关。队列研究存在异质性和可能的发表偏倚。RCT 的效应点估计值效力不足，95%CI 较宽，心血管事件为次要结局，但 RCT 也显示出风险降低的趋势。
