Tumor necrosis factor-α blockade, cardiovascular outcomes, and survival in rheumatoid arthritis

Ziyad Al-Aly, Hui Pan, Angelique Zeringue, Hong Xian, Jay R. McDonald, Tarek Ashkar (El-Achkar), Seth Eisen

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

The effect of TNF-α 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-α 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-α antagonists was not associated with a significant effect on the composite endpoint of cardiovascular outcomes. When each outcome was examined separately, the use TNF-α 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-α antagonists did not affect the risk of death (HR = 0.99; CI = 0.87-1.14). In subgroup analyses, the use TNF-α 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-α 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 TNF-α antagonists is not different than those who receive other DMARDs.

Original languageEnglish (US)
Pages (from-to)10-18
Number of pages9
JournalTranslational Research
Volume157
Issue number1
DOIs
StatePublished - Jan 2011
Externally publishedYes

Fingerprint

Rheumatoid Arthritis
Tumor Necrosis Factor-alpha
Survival
Cerebrovascular Disorders
Hazards
Antirheumatic Agents
Peripheral Arterial Disease
Confidence Intervals
Heart Diseases
Heart Failure
Composite materials
Veterans
Proportional Hazards Models

Keywords

  • Beneficiary Identification and Records Locator Subsystem
  • BIRLS
  • CPT
  • current procedural terminology
  • disease-modifying anti-rheumatic drug
  • DMARD
  • PBM
  • Pharmacy Benefits Management
  • RA
  • rheumatoid arthritis
  • TNF-α
  • tumor necrosis factor-α
  • VA
  • Veterans Administration

ASJC Scopus subject areas

  • Medicine(all)
  • Biochemistry, medical
  • Public Health, Environmental and Occupational Health

Cite this

Tumor necrosis factor-α blockade, cardiovascular outcomes, and survival in rheumatoid arthritis. / Al-Aly, Ziyad; Pan, Hui; Zeringue, Angelique; Xian, Hong; McDonald, Jay R.; Ashkar (El-Achkar), Tarek; Eisen, Seth.

In: Translational Research, Vol. 157, No. 1, 01.2011, p. 10-18.

Research output: Contribution to journalArticle

Al-Aly, Ziyad ; Pan, Hui ; Zeringue, Angelique ; Xian, Hong ; McDonald, Jay R. ; Ashkar (El-Achkar), Tarek ; Eisen, Seth. / Tumor necrosis factor-α blockade, cardiovascular outcomes, and survival in rheumatoid arthritis. In: Translational Research. 2011 ; Vol. 157, No. 1. pp. 10-18.
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