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The effects of biologic agents on cardiovascular risk factors and atherosclerosis in rheumatoid arthritis patients: a prospective observational study

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Abstract

We aimed to evaluate the impact of biologic treatment on subclinical atherosclerosis and risk factors for cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA). Forty-nine biologic naïve RA patients, treated with conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs), who were eligible for treatment with a biologic agent, were included in the study. The serum levels of lipid parameters, as well as disease activity parameters were determined in RA patients before and after 3 and 6 months of therapy. Carotid artery intima-media thickness (cIMT) was measured before and after treatment. A comparison analysis of change of these parameters was also performed between anti-tumor necrosis factor (anti-TNF) and non-anti-TNF users. Furthermore, 31 non-smoking healthy volunteers, matched for age and gender, were used as a control group. At baseline, RA patients had a decrease in serum total cholesterol (TC) and high-density lipoprotein cholesterol (HDL-C) levels compared with controls (209 ± 63 vs 233 ± 44 and 58 ± 15 vs 61 ± 14, p < 0.004), while cIMT was higher versus controls [0.9 (0.8–1) vs 0.6 (0.5–0.7), p < 0.001]. TC, HDL-C and apolipoprotein A1 levels were significantly increased 3 months after treatment (209 ± 63, 58 ± 15, 162 ± 32, vs 227 ± 45, 60 ± 15, 169 ± 29, respectively, p < 0.03) and this observation remained stable at a 6-month follow-up. After 6 months, there was also a statistically significant decrease in the cIMT [0.9 (0.8–1) vs 0.7 (0.6–0.8), p < 0.001]. Anti-TNF and non-anti-TNF users had comparable changes in cardiovascular risk parameters. The atherogenic lipid profile and subclinical atherosclerosis are features of RA, which appeared improved after biologic therapy initiation.

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Acknowledgements

The authors would like to thank the patients who participated in the study.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Internal Medicine, Department of Internal Medicine, Medical School, University of Ioannina, 45110, Ioannina, Greece

    G. V. Papamichail, H. Milionis & P. V. Voulgari

  2. Rheumatology Clinic, Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece

    T. E. Markatseli, A. N. Georgiadis, A. A. Drosos & P. V. Voulgari

  3. Radiology, Department of Radiology, Medical School, University of Ioannina, Ioannina, Greece

    V. G. Xydis

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  1. G. V. Papamichail
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Contributions

GVP: conceptualization, methodology, investigation, writing—original draft preparation; TEM: formal analysis; ANG: investigation; VGX: investigation; HM: methodology; AAD: supervision, critical review and editing; PVV: conceptualization, methodology, supervision, and critical review.

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Correspondence to P. V. Voulgari.

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All the procedures were in accordance with ethical standards and the Helsinki Declaration of 1964 and its later amendments. The study protocol was approved by the Institutional Ethics Committee.

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Papamichail, G.V., Markatseli, T.E., Georgiadis, A.N. et al. The effects of biologic agents on cardiovascular risk factors and atherosclerosis in rheumatoid arthritis patients: a prospective observational study. Heart Vessels 37, 2128–2136 (2022). https://doi.org/10.1007/s00380-022-02114-y

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