1st Department of Cardiology, National and Kapodistrian University of Athens, Hippokration Hospital, 14575, Athens, Greece.
2nd Department of Pathology, National and Kapodistrian University of Athens, Hippokration Hospital, Athens, Greece.
Clin Rheumatol. 2018 Feb;37(2):515-526. doi: 10.1007/s10067-017-3657-y. Epub 2017 May 8.
Patients with rheumatoid arthritis (RA) have higher aortic stiffness and cardiovascular risk. Tumor necrosis factor alpha (TNF-a) antagonists reduce inflammation in RA and are indicated for the treatment of patients with severe active rheumatoid disease. However, it is debatable if they have favorable effects on cardiovascular health. The present meta-analysis evaluates the effect of TNF-a antagonists on aortic stiffness and wave reflections, predictors of cardiovascular events and mortality, in RA patients. A search of PubMed, Cohrane, and Embase databases was conducted to identify studies into the effect of TNF-a antagonists on aortic stiffness in RA patients. Aortic stiffness and wave reflections were assessed by aortic (carotid-femoral [cf]) pulse wave velocity (PWV) and augmentation index (AIx), respectively. cfPWV significantly improved following TNF-a antagonist treatment (mean change: -0.53 m/s, 95% CI: -0.833 to -0.218, p = 0.001), independently of age and clinical response to treatment. A more prominent reduction in cfPWV was associated with etanercept/adalimumab (mean difference: -0.62 m/s, 95% CI: -0.968 to -0.272 m/s, p < 0.001) versus infliximab (mean difference: -0.193 m/s, 95% CI: -0.847 to 0.462 m/s, p = 0.564). TNF-a antagonist treatment induced a significant improvement in AIx (mean change: -1.48%, 95% CI: -2.89 to -0.078%, p = 0.039), but this reduction was influenced by age and clinical response to treatment. The balance of evidence suggests that TNF-a antagonists may have a beneficial effect on aortic stiffness and, therefore, on cardiovascular risk. However, larger, longitudinal studies are warranted to confirm such findings.
类风湿关节炎（RA）患者的主动脉僵硬度和心血管风险较高。肿瘤坏死因子-α（TNF-α）拮抗剂可减轻 RA 中的炎症，适用于治疗严重活动性类风湿疾病患者。然而，它们是否对心血管健康有有利影响仍存在争议。本荟萃分析评估了 TNF-α拮抗剂对 RA 患者主动脉僵硬度和波反射（心血管事件和死亡率的预测指标）的影响。通过搜索 PubMed、Cochrane 和 Embase 数据库，确定了 TNF-α拮抗剂对 RA 患者主动脉僵硬度影响的研究。主动脉僵硬度和波反射分别通过主动脉（颈动脉-股动脉 [cf]）脉搏波速度（PWV）和增强指数（AIx）评估。TNF-α拮抗剂治疗后 cfPWV 显著改善（平均变化：-0.53 m/s，95%CI：-0.833 至 -0.218，p = 0.001），与年龄和治疗临床反应无关。cfPWV 的更显著降低与依那西普/阿达木单抗（平均差异：-0.62 m/s，95%CI：-0.968 至 -0.272 m/s，p < 0.001）相比，与英夫利昔单抗（平均差异：-0.193 m/s，95%CI：-0.847 至 0.462 m/s，p = 0.564）相比。TNF-α拮抗剂治疗可显著改善 AIx（平均变化：-1.48%，95%CI：-2.89 至 -0.078%，p = 0.039），但这种降低受年龄和治疗临床反应的影响。现有证据表明，TNF-α拮抗剂可能对主动脉僵硬度有有益影响，从而降低心血管风险。然而，需要更大的、纵向研究来证实这些发现。
