How Arthritis Medications Can Affect Your Heart
Find out which arthritis drugs increase your heart disease risk, and which ones might lower it.
Arthritis Drugs That Could Harm the Heart
It’s not news that nonsteroidal anti-inflammatory drugs (NSAIDs) are harmful to the heart. Back in 2005, the FDA added a label to these drugs warning that they increase the chance of a heart attack or stroke.
In 2018, based on new research, the agency strengthened its warning, adding that NSAIDs can contribute to a heart attack or stroke within the first few weeks of use, and that the risk increases with longer use and higher doses. The odds of a heart event are highest in people with existing heart disease, but even those with no history of a heart problem could be vulnerable.
“The reason that NSAIDs and COX-2 inhibitors raise risk is not entirely clear,” says rheumatologist Daniel H. Solomon, MD, professor of medicine at Harvard Medical School. “They appear to have a deleterious effect on the body’s ability to keep its blood vessels open, and that raises blood pressure. But they also have beneficial effects on pain.”
When deciding whether to use NSAIDs, balance your need for pain relief with the potential side effects. If you do take these drugs, use the lowest possible dose for the shortest period of time needed to control your pain.
This drug is FDA-approved to treat people with moderate to severe RA that hasn’t improved after they’ve tried at least one DMARD. Yet tocilizumab has been questionable when it comes to the heart.
Studies show the biologic raises LDL cholesterol levels, a known risk factor for heart disease. Whether it increases heart disease risk has been less certain. A 2017 study in Arthritis & Rheumatology found no increased risk of heart attack or stroke among tocilizumab users compared to those using a TNF inhibitor. Other studies have also found comparable heart risks between tocilizumab and other biologic drugs.
However, a 2017 STAT News investigative report linked the drug to hundreds of deaths, many of them heart related. If your doctor recommends this drug, ask whether you should have your cholesterol levels checked and be monitored for heart problems more closely while you’re on it.
Prednisone is a corticosteroid drug that treats RA by reigning in inflammation. Yet it can be damaging to the heart by raising blood pressure, increasing cholesterol levels, and hardening the arteries.
Prednisone also contributes to weight gain, which can independently increase heart disease risk. Studies find that corticosteroids make people who use them more vulnerable to having a heart attack, stroke, heart failure, and other major heart events.
You always want to be on as low a dose of steroids as possible, Dr. Solomon says. “Steroids have an incredible effect at reducing inflammation. So the goal is to balance the potential benefit on pain and function with the deleterious effects on the heart.”
Caring for Your Heart While Treating Arthritis
When you live with arthritis, you have the dual responsibility of protecting your joints and your heart. It’s important to balance the need for arthritis relief with the potential risks of the drugs that treat it.
The silver lining may be that caring for both your heart and your arthritis will keep you eating well, exercising, and tobacco-free, which will help you stay healthier overall.
Roubille C, et al. The effects of tumor necrosis factor inhibitors, methotrexate, non-steroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis. Annals of the Rheumatic Diseases. https://ard.bmj.com/content/74/3/480.
Mangoni A, et al. Methotrexate and cardiovascular protection: Current evidence and future directions. Clinical Medicine Insights: Therapeutics. 2017. https://journals.sagepub.com/doi/full/10.1177/1179559X17741289
Hung YM, et al. The effect of anti-rheumatic medications for coronary artery diseases risk in patients with rheumatoid arthritis might be changed over time: A nationwide population-based cohort study. PLoS One. 2017. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0179081
Low ASL, et al. Relationship between exposure to tumor necrosis factor inhibitor therapy and incidence and severity of myocardial infarction in patients with rheumatoid arthritis. Annals of the Rheumatic Diseases. 2016. https://ard.bmj.com/content/76/4/654
Ljung L, et al. Response to biological treatment and subsequent risk of coronary events in rheumatoid arthritis. Annals of the Rheumatic Diseases. 2015. https://ard.bmj.com/content/75/12/2087.
Monaco C, et al. Anti-TNF therapy: past, present, and future. International Immunology. 2015. https://academic.oup.com/intimm/article/27/1/55/2950852
U.S. Food & Drug Administration. FDA Drug Safety Communication: FDA strengthens warning that non-aspirin nonsteroidal anti-inflammatory drugs (NSAIDs) can cause heart attacks or strokes. https://www.fda.gov/Drugs/DrugSafety/ucm451800.htm
Kim SC, et al. Cardiovascular safety of tocilizumab versus tumor necrosis factor inhibitors in patients with rheumatoid arthritis: A multi database cohort study. Arthritis & Rheumatology. 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5573926/
Xie F, et al. OP0193 tocilizumab and the risk for cardiovascular disease events among rheumatoid arthritis patients: a direct comparison in a real world setting. Annals of the Rheumatic Diseases. 2018. https://ard.bmj.com/content/77/Suppl_2/145.2
Piller, Charles. Failure to warn: Hundreds died while taking an arthritis drug, but nobody alerted patients. STAT News. https://www.statnews.com/2017/06/05/actemra-rheumatoid-arthritis-fda/
Crawson CS, et al. Rheumatoid arthritis and cardiovascular disease. American Heart Journal. 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3890244/
Roubille C, et al. The effects of tumour necrosis factor inhibitors, methotrexate, nonsteroidal anti-inflammatory drugs and corticosteroids on cardiovascular events in rheumatoid arthritis, psoriasis and psoriatic arthritis: a systematic review and meta-analysis. Annals of the Rheumatic Diseases. 2015. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4345910/
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