Rheumatoid arthritis patients should take a few things away from research that Daniel Solomon presented on July 14 at the annual meeting of the Florida Society of Rheumatology in Orlando, the Harvard Medical School and Brigham and Women’s physician told CreakyJoints.
“Rheumatoid arthritis is a risk factor for heart attacks and strokes,” Solomon said, and the heart-attack risk involves both traditional risk factors, as well as those specifically associated with rheumatoid arthritis, like disease activity.
A National Institutes of Health-sponsored trial called TARGET is testing the ways a range of rheumatoid arthritis treatments may impact heart attack risks in different ways.
“For now, patients with known heart disease and rheumatoid arthritis should avoid nonsteroidal anti-inflammatory drugs (NSAIDs) and lower their steroid dosage as much as possible,” Solomon said.
In the Orlando talk, Solomon said that reducing inflammation in rheumatoid arthritis patients also decreases their risk of heart attack, but questions remain about the nature of the impact treating inflammation will have on heart attacks, MedPage reports.
Rheumatoid arthritis patients are at a one-and-a-half times higher risk for heart attack, and that risk is likely underestimated, according to a 2018 study in Rheumatic Diseases Clinics. “Per recent recommendations, to reduce cardiovascular risk in rheumatoid arthritis, control disease activity, reduce inflammation, and aggressively treat cardiovascular risk factors,” it states.
At the Orlando conference, Solomon cited nearly two decades of evidence that inflammation plays an important role in heart attack development, MedPage reports. “In the general population, this has been found over and over again, including in a meta-analysis of 54 studies looking at the relationship of inflammatory C-reactive protein and coronary heart disease and vascular deaths,” Solomon said at the conference.
A 2017 trial called CANTOS suggested that blocking IL-1, proteins that regulate inflammation, could also lower heart attack risk. Although the study found just a 15 percent reduction over five years, that “relatively-small” result was “proof of concept that if you use a drug that has no impact on traditional risk factors, lipids, blood pressure, or diabetes, you could actually have a reduction in cardiovascular risk,” Solomon said at the Orlando event.
Solomon added that he and colleagues found, in 2003, that heart attack risk was doubled in women with rheumatoid arthritis, and that there is a need for new tools with which to evaluate risk accurately. He and colleagues created a prediction score for heart attacks among rheumatoid arthritis patients based on a cohort of 23,000 people. The researchers found that the tool could predict heart-attack risk at a better rate of 17 percent, he said.
Typically, then, patients’ cardiovascular profiles probably should impact their physicians’ decisions when it come to selecting medications, according to Solomon. “But we need more information,” he said in the talk. “Inflammation predicts atherosclerosis, but it’s still unclear if treating inflammation in rheumatoid arthritis reduces cardiovascular risk. It likely does, but I’m an evidence-based practitioner and I want to see that trial that shows me that.”
Solomon and colleagues have been enrolling patients in the TARGET study, MedPage reports, and after signing 53 people up to date, they hope to reach 200 patients from 35 sites. He urged audience members at the Orlando event to enroll their patients too, per MedPage