Table 2.
Anti-rheumatic drugs and cardiovascular risk
| Agent | Effect on risk biomarkers | Effect on CV outcome |
|---|---|---|
| Glucocorticoids | ↑BP, ↑TG, ↑glucose, ↓CRP | Prolonged high dose: worsen40,41,47 Suppression of active SLE protective39 |
| NSAIDs/COXIBs | ↑BP, ↑thrombosis risk, ↓renal function | Worsen. May improve in RA83–85 |
| MTX | ↓CRP, ↑adenosine | ↓Risk in observational studies66 |
| Mycophenolate | ↓CRP and plaque inflammation98 | Minimal data47 |
| Hydroxychloroquine | ↓LDL, ↓thrombosis risk | Reduced risk in RA and SLE64 |
| Anti-TNFα | ↓CRP, ↑LDL, ↑TG54 | Worsens cardiac failure. ↓May MI risk67,68,93,94 |
| Anti-IL-6 | ↓CRP, ↓FN, ↑LDL, ↑TG54 | No data64 |
| Anti-IL-1 | ↓CRP, ↓FN, ↓IL-664 | No data, study in progress |
| B-cell depletion | Long-term treatment may ↓LDL64 | No data |
| Cyclosporine | ↑BP, ↑LDL, ↓renal function | Worsen |
BP, blood pressure; TG, triglycerides; LDL, low-density lipoprotein; CRP, C-reactive protein; NSAIDs, traditional non-steroidal anti-inflammatory drugs; COXIBs, COX-2 selective anti-inflammatory drugs; RA, rheumatoid arthritis; MTX, Methotrexate; SLE, systemic lupus erythematosus; FN, fibrinogen; IL-6, interleukin-6.