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Methotrexate can prevent cardiovascular events in patients with rheumatoid arthritis: An updated meta-analysis

Kai-Jun Sun1, Lei-Ling Liu, Jia-Hui Hu

  • 1Department of Cardiovascular Medicine, The Second Xiangya Hospital, Central South University, 139 Middle Renmin Road, Changsha, Hunan, China.

Medicine
|February 20, 2021
PubMed

Insights

Methotrexate (MTX) significantly reduces cardiovascular events in rheumatoid arthritis (RA) patients. This study indicates MTX is a viable option for preventing heart issues in RA, but not for coronary heart disease patients.

Area of Science:

  • Rheumatology
  • Cardiology
  • Pharmacology

Background:

  • Patients with rheumatoid arthritis (RA) face a higher risk of cardiovascular events (CVEs) due to chronic inflammation promoting atherosclerosis.
  • Conventional synthetic anti-rheumatic drugs, such as methotrexate (MTX), are used to manage RA and may mitigate cardiovascular risk.

Purpose of the Study:

  • To determine if methotrexate (MTX) can prevent cardiovascular events (CVEs) in patients with rheumatoid arthritis (RA).
  • To explore the potential of MTX in preventing recurrent CVEs in patients with coronary heart disease (CHD).

Main Methods:

  • A meta-analysis was conducted, searching major databases (PubMed, Embase, Web of Science, Cochrane Library).
  • Keywords included "methotrexate," "cardiovascular," "rheumatoid arthritis," and specific CVEs.
  • The primary efficacy outcome was a composite of CVEs, including angina, acute coronary syndrome, stroke, heart failure, and cardiac death.

Main Results:

  • The meta-analysis included 10 studies with 195,416 RA patients.
  • Methotrexate (MTX) demonstrated a significant preventive effect on CVEs in RA patients (RR: 0.798, 95% CI 0.726-0.876, P=.001).
  • The heterogeneity among studies was low (I2=27.9%).

Conclusions:

  • Methotrexate (MTX) is effective in preventing cardiovascular events (CVEs) in patients diagnosed with rheumatoid arthritis (RA).
  • Current evidence is insufficient to support the use of MTX for treating coronary heart disease (CHD) or preventing recurrent CVEs in CHD patients.
Abstract

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