Rheumatology Unit, Department of Experimental and Internal Medicine, University of Messina, Messina, Italy.
Department of Functional Biology, Immunology Area, Faculty of Medicine, University of Oviedo, Oviedo, Spain.
Nat Rev Rheumatol. 2021 May;17(5):270-290. doi: 10.1038/s41584-021-00593-3. Epub 2021 Apr 8.
The risk of cardiovascular disease is increased in patients with rheumatoid arthritis compared with the general population owing to the influence of traditional and non-traditional risk factors. Inflammation has a pivotal contribution and can accelerate the atherosclerotic process. Although dampening inflammation with DMARDs should theoretically abrogate this process, evidence suggests that these drugs can also promote atherosclerosis directly and indirectly, hence adding to an increased cardiovascular burden. However, the extent and direction of the effects largely differ across drugs. Understanding how these drugs influence endothelial damage and vascular repair mechanisms is key to understanding these outcomes. NSAIDs and glucocorticoids can increase the cardiovascular risk. Conversely, conventional, biologic and targeted DMARDs control inflammation and reduce this risk, although some of these drugs can also aggravate traditional factors or thrombotic events. Given these data, the fundamental objective for clinicians should be disease control, in an individualized approach that considers the most appropriate drug for each patient, taking into account joint and cardiovascular outcomes. This Review provides a comprehensive analysis of the effects of DMARDs and other approved drugs on cardiovascular involvement in rheumatoid arthritis, from a clinical and mechanistic perspective, with a roadmap to inform the research agenda.
由于传统和非传统危险因素的影响，类风湿关节炎患者的心血管疾病风险高于一般人群。炎症起着关键作用，可以加速动脉粥样硬化过程。虽然 DMARD 类药物抑制炎症理论上可以阻断这一过程，但有证据表明，这些药物也可以直接和间接促进动脉粥样硬化，从而增加心血管负担。然而，这些药物的影响程度和方向在很大程度上因药物而异。了解这些药物如何影响内皮损伤和血管修复机制是理解这些结果的关键。非甾体抗炎药和糖皮质激素会增加心血管风险。相反，传统的、生物的和靶向的 DMARD 类药物可以控制炎症并降低这种风险，尽管其中一些药物也会加重传统因素或血栓事件。鉴于这些数据，临床医生的基本目标应该是个体化控制疾病，考虑到每位患者的最佳药物，同时考虑到关节和心血管结局。本综述从临床和机制的角度，全面分析了 DMARD 类药物和其他已批准药物对类风湿关节炎心血管受累的影响，并制定了路线图以指导研究议程。
