Cardiovascular disease ( CVD ) is the leading cause of death in rheumatoid arthritis ( RA ) patients. This study is the first to report the association of Hydroxychloroquine ( Plaquenil; an antirheumatic medication that has been associated with decreased risk of diabetes, a less atherogenic lipid profile, and antithrombotic properties ) with cardiovascular disease in rheumatoid arthritis.
A retrospective incident cohort of patients with rheumatoid arthritis from January 1, 2001, to October 31, 2013, excluding patients with cardiovascular disease prior to diagnosis of rheumatoid arthritis, was constructed.
Patients were categorized as Hydroxychloroquine users versus nonusers and were allowed to contribute time to either group according to Hydroxychloroquine exposure.
The primary outcome was adjudicated incident cardiovascular disease defined as a composite of coronary artery disease, stroke, transient ischemic attack, sudden cardiac death, and peripheral artery disease with arterial revascularization procedure.
The secondary outcome was a composite of incident coronary artery disease, stroke, and transient ischemic attack.
Researchers included 1266 patients with rheumatoid arthritis, 547 Hydroxychloroquine users, and 719 nonusers.
During the observation period, 102 cardiovascular events occurred, 3 in Hydroxychloroquine users and 99 in nonusers.
The fully adjusted Cox model showed a hazard ratio of 0.28 ( 95% CI 0.12-0.63, P=0.002 ) for incident cardiovascular disease and 0.30 ( 95% CI 0.13-0.68, P=0.004 ) for incident composite coronary artery disease, stroke, and transient ischemic attack ( TIA ) for Hydroxychloroquine users versus nonusers, respectively.
In conclusion, in this hypothesis-generating study, Hydroxychloroquine use was associated with a 72% decrease in the risk of incident cardiovascular disease in patients with rheumatoid arthritis.
If these preliminary results are confirmed in larger studies, the findings may be used as a rationale for a randomized study of Hydroxychloroquine use for primary prevention of cardiovascular disease in patients with rheumatoid arthritis or nonrheumatic high-risk patients. ( Xagena )
Sharma TS et al, J Am Heart Assoc 2016;5(1). pii: e002867. doi: 10.1161/JAHA.115.002867.