No retraction, correction or concern found when last checked on Oct 31, 2026.

Reduction in the incidence of myocardial infarction in patients with rheumatoid arthritis who respond to anti–tumor necrosis factor α therapy: Results from the British Society for Rheumatology Biologics Register

W. G. Dixon, K. D. Watson, M. Lunt and 3 more

Arthritis & Rheumatism · 2007

Abstract

Objective Rheumatoid arthritis (RA) is associated with an increased risk of coronary artery disease, possibly acting via shared mechanisms of inflammation. This study was undertaken to test the hypothesis that the powerful antiinflammatory effect of anti–tumor necrosis α (anti‐TNFα) therapy might lead to a reduction in the incidence of myocardial infarction (MI) in patients with RA. Methods Using data from the British Society for Rheumatology Biologics Register, a national prospective observational study, we compared MI rates in 8,670 patients with RA treated with anti‐TNFα and 2,170 patients with active RA treated with traditional disease‐modifying antirheumatic drugs (DMARDs). Results Through July 2006, 63 MIs occurred in the anti‐TNFα cohort during 13,233 person‐years of followup and 17 MIs occurred in the DMARD cohort during 2,893 person‐years of followup, equivalent to a rate of 4.8 events per 1,000 person‐years and 5.9 events per 1,000 person‐years, respectively. After adjustment for baseline risk factors, there was no reduction in the rate of MI in the anti‐TNFα cohort compared with the DMARD cohort (incidence rate ratio 1.44 [95% confidence interval 0.56–3.67]). In an analysis of anti‐TNFα–treated patients who responded to the treatment within 6 months versus those who did not, MI rates were found to be 3.5 events per 1,000 person‐years in responders and 9.4 events per 1,000 person‐years in nonresponders. The adjusted incidence rate ratio (95% confidence interval) for responders compared with nonresponders was 0.36 (0.19–0.69). Conclusion These results indicate that RA patients treated with anti‐TNFα do not have a lower incidence of MI compared with RA patients treated with traditional DMARDs. However, the risk of MI is markedly reduced in those who respond to anti‐TNFα therapy by 6 months compared with nonresponders. This finding supports the notion that inflammation plays a pivotal role in MI.

Shown for reading. Its publisher allows quoting it, not republishing it.

References 36

1.
Goodson NJ, Wiles NJ, Lunt M, Barrett EM, Silman AJ, Symmons DP. Mortality in early inflammatory polyarthritis: cardiovascular mortality is increased in seropositive patients. Arthritis Rheum. 2002;46:2010-9.
Not in our library10.1002/art.10419
2.
Maradit-Kremers H, Crowson CS, Nicola PJ, Ballman KV, Roger VL, Jacobsen SJ, et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum. 2005;52:402-11.
Not in our library10.1002/art.20853
3.
Wolfe F, Freundlich B, Straus WL. Increase in cardiovascular and cerebrovascular disease prevalence in rheumatoid arthritis. J Rheumatol. 2003;30:36-40.
Not in our library
4.
Symmons DP, Jones MA, Scott DL, Prior P. Longterm mortality outcome in patients with rheumatoid arthritis: early presenters continue to do well. J Rheumatol. 1998;25:1072-7.
Not in our library
5.
Solomon DH, Karlson EW, Rimm EB, Cannuscio CC, Mandl LA, Manson JE, et al. Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation. 2003;107:1303-7.
Not in our library10.1161/01.cir.0000054612.26458.b2
6.
Del Rincon ID, Williams K, Stern MP, Freeman GL, Escalante A. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum. 2001;44:2737-45.
Not in our library10.1002/1529-0131(200112)44:12<2737::aid-art460>3.0.co;2-#
7.
Goodson NJ, Symmons DP, Scott DG, Bunn D, Lunt M, Silman AJ. Baseline levels of C-reactive protein and prediction of death from cardiovascular disease in patients with inflammatory polyarthritis: a ten-year followup study of a primary care–based inception cohort. Arthritis Rheum. 2005;52:2293-9.
Not in our library10.1002/art.21204
8.
Maradit-Kremers H, Nicola PJ, Crowson CS, Ballman KV, Gabriel SE. Cardiovascular death in rheumatoid arthritis: a population-based study. Arthritis Rheum. 2005;52:722-32.
Not in our library10.1002/art.20878
9.
Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352:1685-95.
Not in our library10.1056/nejmra043430
10.
Feldmann M, Brennan FM, Williams RO, Woody JN, Maini RN. The transfer of a laboratory based hypothesis to a clinically useful therapy: the development of anti-TNF therapy of rheumatoid arthritis. Best Pract Res Clin Rheumatol. 2004;18:59-80.
Not in our library10.1016/j.berh.2003.09.010
11.
Weinblatt ME, Keystone EC, Furst DE, Moreland LW, Weisman MH, Birbara CA, et al. Adalimumab, a fully human anti–tumor necrosis factor α monoclonal antibody, for the treatment of rheumatoid arthritis in patients taking concomitant methotrexate: the ARMADA trial. Arthritis Rheum. 2003;48:35-45.
Not in our library10.1002/art.10697
12.
Moreland LW, Schiff MH, Baumgartner SW, Tindall EA, Fleischmann RM, Bulpitt KJ, et al. Etanercept therapy in rheumatoid arthritis: a randomized, controlled trial. Ann Intern Med. 1999;130:478-86.
Not in our library10.7326/0003-4819-130-6-199903160-00004
13.
Maini R, St Clair EW, Breedveld F, Furst D, Kalden J, Weisman M, et al. Infliximab (chimeric anti-tumour necrosis factor α monoclonal antibody) versus placebo in rheumatoid arthritis patients receiving concomitant methotrexate: a randomised phase III trial. Lancet. 1999;354:1932-9.
Not in our library10.1016/s0140-6736(99)05246-0
14.
Sattar N, McCarey DW, Capell H, McInnes IB. Explaining how “high-grade” systemic inflammation accelerates vascular risk in rheumatoid arthritis. Circulation. 2003;108:2957-63.
Not in our library10.1161/01.cir.0000099844.31524.05
15.
Libby P. Inflammation in atherosclerosis. Nature. 2002;420:868-874.
Not in our library10.1038/nature01323
16.
Carter AM. Inflammation, thrombosis and acute coronary syndromes. Diab Vasc Dis Res. 2005;2:113-21.
Not in our library10.3132/dvdr.2005.018
17.
Grignani G, Maiolo A. Cytokines and hemostasis. Haematologica. 2000;85:967-72.
Not in our library
18.
Jacobsson LT, Turesson C, Gulfe A, Kapetanovic MC, Petersson IF, Saxne T, et al. Treatment with tumor necrosis factor blockers is associated with a lower incidence of first cardiovascular events in patients with rheumatoid arthritis. J Rheumatol. 2005;32:1213-8.
Not in our library
19.
Watson K, Symmons D, Griffiths I, Silman A. The British Society for Rheumatology Biologics Register. Ann Rheum Dis. 2005;64(Suppl 4):iv42-3.
Not in our library10.1136/ard.2005.042499
20.
Prevoo ML, van 't Hof MA, Kuper HH, van Leeuwen MA, van de Putte LB, van Riel PL. Modified disease activity scores that include twenty-eight–joint counts: development and validation in a prospective longitudinal study of patients with rheumatoid arthritis. Arthritis Rheum. 1995;38:44-8.
Not in our library10.1002/art.1780380107
21.
Ledingham J, Deighton C. Update on the British Society for Rheumatology guidelines for prescribing TNFα blockers in adults with rheumatoid arthritis (update of previous guidelines of April 2001) [published erratum appears in Rheumatology (Oxford) 2006;45:1170]. Rheumatology (Oxford). 2005;44:157-63.
Not in our library10.1093/rheumatology/keh464
22.
2002.
Not in our library
23.
Kirwan JR, Reeback JS. Stanford Health Assessment Questionnaire modified to assess disability in British patients with rheumatoid arthritis. Br J Rheumatol. 1986;25:206-9.
Not in our library10.1093/rheumatology/25.2.206
24.
Townsend P. Deprivation. J Soc Policy. 1987;16:125-46.
Not in our library
25.
International statistical classification of diseases and related health problems, tenth revision. 1992.
Not in our library
26.
Myocardial infarction redefined—a consensus document of The Joint European Society of Cardiology/American College of Cardiology Committee for the redefinition of myocardial infarction. Eur Heart J. 2000;21:1502-13.
Not in our library10.1053/euhj.2000.2305
27.
Van Gestel AM, Prevoo ML, van 't Hof MA, van Rijswijk MH, van de Putte LB, van Riel PL. Development and validation of the European League Against Rheumatism response criteria for rheumatoid arthritis: comparison with the preliminary American College of Rheumatology and the World Health Organization/International League Against Rheumatism criteria. Arthritis Rheum. 1996;39:34-40.
Not in our library10.1002/art.1780390105
28.
Levine B, Kalman J, Mayer L, Fillit HM, Packer M. Elevated circulating levels of tumor necrosis factor in severe chronic heart failure. N Engl J Med. 1990;323:236-41.
Not in our library10.1056/nejm199007263230405
29.
Rauchhaus M, Doehner W, Francis DP, Davos C, Kemp M, Liebenthal C, et al. Plasma cytokine parameters and mortality in patients with chronic heart failure. Circulation. 2000;102:3060-7.
Not in our library10.1161/01.cir.102.25.3060
30.
Anker SD, Coats AJ. How to RECOVER from RENAISSANCE? The significance of the results of RECOVER, RENAISSANCE, RENEWAL and ATTACH. Int J Cardiol. 2002;86:123-30.
Not in our library10.1016/s0167-5273(02)00470-9
31.
Chung ES, Packer M, Lo KH, Fasanmade AA, Willerson JT. Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-α, in patients with moderate-to-severe heart failure: results of the anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial. Circulation. 2003;107:3133-40.
Not in our library10.1161/01.cir.0000077913.60364.d2
32.
Kurrelmeyer KM, Michael LH, Baumgarten G, Taffet GE, Peschon JJ, Sivasubramanian N, et al. Endogenous tumor necrosis factor protects the adult cardiac myocyte against ischemic-induced apoptosis in a murine model of acute myocardial infarction. Proc Natl Acad Sci U S A. 2000;97:5456-61.
Not in our library10.1073/pnas.070036297
33.
Mann DL. Stress-activated cytokines and the heart: from adaptation to maladaptation. Annu Rev Physiol. 2003;65:81-101.
Not in our library10.1146/annurev.physiol.65.092101.142249
34.
Shah PK. Insights into the molecular mechanisms of plaque rupture and thrombosis. Indian Heart J. 2005;57:21-30.
Not in our library
35.
Tunstall-Pedoe H, Kuulasmaa K, Mahonen M, Tolonen H, Ruokokoski E, Amouyel P. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet. 1999;353:1547-57.
Not in our library10.1016/s0140-6736(99)04021-0
36.
Watson DJ, Rhodes T, Guess HA. All-cause mortality and vascular events among patients with rheumatoid arthritis, osteoarthritis, or no arthritis in the UK General Practice Research Database. J Rheumatol. 2003;30:1196-202.
Not in our library

Cited by papers we hold 8

Reads

Read by people on this page

None yet.

Checked or read by AI through naulon

None yet.

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.

Are you an author?

Is this your paper?

Claim it to add your note and be paid when agents cite it. Free.