Bălănescu Andra-Rodica, Bojincă Violeta Claudia, Bojincă Mihai, Donisan Teodora, Bălănescu Serban Mihai
Department of Internal Medicine and Rheumatology, 'Sf. Maria' Clinical Hospital, 'Carol Davila' University of Medicine and Pharmacy, 011172 Bucharest, Romania.
Department of Internal Medicine and Rheumatology, 'Dr. Ion Cantacuzino' Hospital, 'Carol Davila' University of Medicine and Pharmacy, 011172 Bucharest, Romania.
Exp Ther Med. 2019 Feb;17(2):1024-1029. doi: 10.3892/etm.2018.6992. Epub 2018 Nov 19.
The cardiovascular effects of disease-modifying antirheumatic drugs and particularly of methotrexate (MTX) are complex and frequently incorrectly understood, which might lead to the unjustified discontinuation of this treatment. MTX, 'the gold standard' and first line treatment in rheumatoid arthritis, psoriatic arthritis, and other immune-mediated inflammatory diseases, has been proven to decrease inflammation, improve cardiovascular risk factors, and reduce mortality. This is supported by both the mechanism of action, as well as a body of clinical data evidence. MTX's cardiovascular effects, although incompletely understood, are explained by its antiproliferative, immunosuppressive, anti-inflammatory, and antiatherogenic effects. Several clinical trials have shown that MTX is associated with improved endothelial function, slower atherosclerosis progression, decreased risk of major cardiovascular adverse events, and benefits on survival. Given its systemic cardiovascular effects, MTX could be regarded as an important therapeutic agent not only to control disease activity in rheumatic diseases, but also to reduce cardiovascular risk and mortality.
改善病情抗风湿药，尤其是甲氨蝶呤（MTX）对心血管系统的影响较为复杂，且常常被误解，这可能导致不合理地停用这种治疗方法。MTX是类风湿关节炎、银屑病关节炎及其他免疫介导的炎症性疾病的“金标准”和一线治疗药物，已被证明可减轻炎症、改善心血管危险因素并降低死亡率。这得到了作用机制以及大量临床数据证据的支持。MTX对心血管系统的影响虽尚未完全明确，但可通过其抗增殖、免疫抑制、抗炎和抗动脉粥样硬化作用来解释。多项临床试验表明，MTX与改善内皮功能、减缓动脉粥样硬化进展、降低主要心血管不良事件风险以及对生存有益相关。鉴于其对心血管系统的全身性影响，MTX不仅可被视为控制风湿性疾病病情活动的重要治疗药物，还可用于降低心血管风险和死亡率。
