Infliximab (Remicade) Linked to Atherosclerosis

Patient Expert

Over the past few years, studies have shown that people with rheumatoid arthritis and other rheumatic diseases have a higher risk of cardiovascular disease because of inflammation throughout the body.   This can be compounded by lack of physical activity, since exercise and physical activity from household chores helps keep weight in check and the cardiovascular system healthy.   Studies have also shown that people with rheumatoid arthritis are more likely to die when they do have a heart attack than people without RA because of inflammation throughout the body.

So will keeping arthritis in check with medication and decreasing overall inflammation have a beneficial effect on the arteries?   Maybe not.   New research from the Netherlands shows that tumour necrosis factor (TNF)-alpha blocker, Remicade (Infliximab), could actually promote atherosclerosis in patients.   The study showed rheuamatoid arthritis patients taking infliximab had an increased atherogenic index and higher level of total cholesterol a year after treatment was initiated.

The study 55 rheumatoid arthritis patients and 55 controls were assessed to get a baseline lipid profile including cholesterol level and atherogenic index.   The RA patients all had active disease, as shown by a tested disease activity score and all were starting therapy with infliximab.   At one year, 31 RA patients were reassessed for lipid profile. HDL cholesterol levels (bad cholesterol) were similar to those at baseline but the atherogenic index was 4 per cent higher than baseline. Total cholesterol had also increased.

It really bothers me to read that TNF-alpha blockers may add to the increased cardiovascular risk that rheumatoid arthritis patients are known to have.   I have taken Humira for almost two years now.   I also have a family history of high cholesterol and heart disease, plus I've had RA for nearly my entire life.   My cholesterol has been over 200 for almost 15 years, but because I'm only 31, doctors have given me a pass on taking statins until recently.   I fought it, even though my entire family takes them.   I was convinced that if I ate healthy enough, that I wouldn't have to take one more medication.   But I recently went to a cardiologist for the first time and he told me that even though his tests show that I'm healthy, that I already have the arteries of someone 10-15 years older than me.   Without medication, I'll have the arteries of a 60 year old when I'm 40.   But he didn't say anything about my arthritis medication making things worse.   Maybe this study is too new.   I'm sure Centocor, Inc will be working furiously to produce research that refutes this new research, or will at least try to implicate all the other TNF-inhibitors as well.   I guess it's a good thing he started me on a cholesterol drug last month.   I hate having one more medication to take for the rest of my life, but he said I could become a strict vegetarian or vegan and my genetics would still win, I wouldn't drop my cholesterol by more than maybe 20 points.   Certainly not enough to decrease my risk of having a heart attack or stroke.

Do you take Remicade, statins, or both?   Are you worried about the reported cardiovascular risks associated with RA?