Be Heart Smart
Get smart about how rheumatoid arthritis drugs affect your heart.
The medications you count on to soothe the painful, swollen joints may also affect your heart. That’s of special concern if you live with rheumatoid arthritis (RA), because research has shown that the chronic inflammation that is the hallmark of the disease can double your risk of a heart attack.
Here is what experts have to say on some of the most common arthritis drugs and your risks for heart attacks, heart failure and stroke.
Most traditional disease-modifying anti-rheumatic drugs (DMARDs) appear to lower the risk of heart attacks and strokes, says Martin Jan Bergman, MD, chief of rheumatology at Taylor Hospital in Ridley Park, Pa.
“The longer you take them, the lower the risk,” says Dr. Bergman, who is analyzing data from the Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis (QUEST-RA) program. His latest results show that taking methotrexate for just one year decreased risk of heart attack by 18 percent and decreased risk for stroke by 11 percent.
The DMARDs sulfasalazine (Azulfidine) and leflunomide (Arava) had similar effects, Dr. Bergman says, while gold sodium thiomalate (Myochrysine) and antimalarials like hydroxychloroquine (Plaquenil), seemed to have little impact on cardiovascular risks.
Biologic drugs that block a chemical signal that spurs inflammation, called tumor necrosis factor alpha blockers, or TNF- a blockers, have revolutionized the treatment of RA. The data on how they affect the heart, however, is murky.
While research showed a decrease in risk of cardiovascular disease and heart attacks among people with RA who took TNF blockers, heart failure appears to be another story.
People with heart failure have high levels of TNF-a, so it was initially thought that TNF-a blocker drugs might be a treatment for this condition, says Daniel H. Solomon, MD, chief of clinical sciences in the division of rheumatology at Brigham and Women’s Hospital in Boston.
This research did not pan out. “The preponderance of data suggests that we should be very cautious about the use of these agents” in people with RA who also have heart failure, he says.
There have been many news reports about how pain-killing drugs known as COX-2 blockers increase heart attack and stroke risks. Additional studies suggested that older non- steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen could also elevate heart risks.
While these drugs are still under scrutiny, a new review of six studies of celicoxib (Celebrex) compared to a placebo in nearly 8,000 patients, which was published in the March 2008 issue of the journal Circulation, found that people with no established risk factors for heart disease, such as high cholesterol or high blood pressure, could safely take doses of up to 400 mg, twice a day, with no increase in the risk of cardiovascular events. Patients at moderate to high risk of heart disease, however, experienced more cardiovascular events when they took either 200 or 400 mg of Celebrex twice a day than if they took a single daily dose. Doctors think taking Celebrex just once a day may be the safest option for high-risk patients because it elevates blood pressure.
The jury is still out on every NSAID. “It seems,” Dr. Solomon says, that based on available research, “the NSAID that is safest for the heart is naproxen.”