Tumor necrosis factor-α blockade, cardiovascular outcomes, and survival in rheumatoid arthritis
Tumor necrosis factor-α blockade, cardiovascular outcomes, and survival in rheumatoid arthritis
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DOI：
10.1016/j.trsl.2010.09.005
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发表时间：
2011-01-01
影响因子：
7.8
通讯作者：
Eisen, Seth
中科院分区：
文献类型：
--
作者：
Al-Aly, Ziyad;Pan, Hui;Eisen, Seth
TNF-α阻断对类风湿性关节炎（RA）患者心血管结局风险和长期生存率的影响尚不清楚。我们收集了一组20，811（75，329人年）的美国退伍军人，他们在1998年10月至2005年9月期间被诊断患有RA，并接受了疾病缓解抗风湿药物（DMARD）治疗。建立了考克斯生存模型，以检查TNF-α拮抗剂对心血管结局复合终点（定义为动脉粥样硬化性心脏病、充血性心力衰竭、外周动脉疾病或脑血管疾病的发生）风险和死亡风险的影响。TNF-α拮抗剂治疗对心血管结局复合终点无显著影响。当分别检查每个结果时，使用INF-α拮抗剂与动脉粥样硬化性心脏病、充血性心力衰竭或外周动脉疾病的风险增加无关，但与脑血管疾病的风险降低相关（风险比（HR）= 0.83;置信区间（CI）= 0.70-0.98）。TNF-α拮抗剂的使用不影响死亡风险（HR = 0.99; CI = 0.87-1.14）。在亚组分析中，在年龄小于我们队列中位年龄（63岁）的患者中，使用INF-α拮抗剂与心血管结局风险降低相关（HR = 0.90，CI = 0.83-0.98）。TNF-α拮抗剂的使用与任何其他亚组的死亡风险变化无关。这些结果表明，接受INF-α拮抗剂治疗的患者的心血管事件风险和生存率与接受其他DMARD治疗的患者没有差异。（翻译研究2011;157：10-18）
The effect of TNF-alpha blockade on the risk of cardiovascular outcomes and long-term survival in patients with rheumatoid arthritis (RA) is not known. We assembled a cohort of 20,811 (75,329 person-years) U.S. veterans who were diagnosed with RA between October 1998 and September 2005, and who were treated with a disease-modifying anti-rheumatic drug (DMARD). Cox survival models were built to examine the effect of TNF-alpha antagonists on the risk of a composite endpoint of cardiovascular outcomes defined as the occurrence of atherosclerotic heart disease, congestive heart failure, peripheral artery disease, or cerebrovascular disease, and on the risk of death. Treatment with TNF-alpha antagonists was not associated with a significant effect on the composite endpoint of cardiovascular outcomes. When each outcome was examined separately, the use INF-alpha antagonists was not associated with an increased risk of atherosclerotic heart disease, congestive heart failure, or peripheral artery disease, but it was associated with decreased risk of cerebrovascular disease (hazard ratio (HR) = 0.83; confidence interval (CI) = 0.70-0.98). The use of TNF-alpha antagonists did not affect the risk of death (HR = 0.99; CI = 0.87-1.14). In subgroup analyses, the use INF-alpha antagonists was associated with a reduced risk of cardiovascular outcomes (HR = 0.90, CI = 0.83-0.98) in patients younger than the median age of our cohort (63 years). The use TNF-alpha antagonists was not associated with a change in the risk of death in any other subgroup. These results show that the risk of cardiovascular events and survival in patients who receive INF-alpha antagonists is not different than those who receive other DMARDs. (Translational Research 2011;157:10-18)