Biologics may prevent cardiovascular events in rheumatoid arthritis by inhibiting coronary plaque formation and stabilizing high-risk lesions.
- Author(s): Karpouzas, George A
- Ormseth, Sarah R
- Hernandez, Elizabeth
- Budoff, Matthew J
- et al.
Published Web Locationhttps://doi.org/10.1002/art.41293
OBJECTIVES:To evaluate if biologic disease-modifying antirheumatic drugs (bDMARDs) decrease cardiovascular disease (CVD) risk in rheumatoid arthritis and whether potential benefits might be rendered by impacting coronary plaque formation or progression. METHODS:In this single-center observational cohort study, 150 patients underwent computed tomography angiography for evaluation of coronary atherosclerosis (total, non-calcified, mixed/calcified and low-attenuation plaque); 101 had repeat assessments within 6.9±0.3 years to evaluate plaque progression. All CVD events were prospectively recorded, including cardiac death, myocardial infarction, unstable angina, revascularization, stroke, claudication, and heart failure hospitalization. The Framingham-D'Agostino score assessed cardiovascular risk. Segment stenosis score measured plaque burden. RESULTS:After adjusting for segment stenosis score, Framingham-D'Agostino score and time-varying DAS28-CRP using marginal structural models, current bDMARD use associated with lower long-term CVD risk (OR=0.15 [95%CI=0.04-0.60]). Non-calcified and low-attenuation plaque presence moderated the effect of bDMARDs on CVD risk; specifically, bDMARD use associated with lower CVD risk in patients with non-calcified or low-attenuation plaque at baseline (OR=0.21 [95%CI=0.04-0.99] and OR=0.08 [95%CI=0.01-0.70], respectively) but not those without. Per-segment plaque progression analyses showed that bDMARD exposure associated with transition of non-calcified to mixed/calcified plaque (OR=4.00 [95%CI=1.05-15.32]). bDMARD exposure predicted lower likelihood of new plaque forming in segments without plaque among patients without mixed/calcified plaque in other coronary segments (OR=0.40 [95%CI=0.17-0.93]), but not among those with calcification. bDMARD treatment also predicted low-attenuation plaque loss (p=0.042). CONCLUSION:In rheumatoid arthritis, bDMARD use associated with reduced CVD risk, protective calcification of non-calcified lesions and lower likelihood of new plaque formation in patients with early atherosclerosis.