Objective. To assess the association between the use of biological disease-modifying antirheumatic drugs (bDMARDs) and the risk of cardiovascular events in patients with systemic inflammatory conditions. Methods. Eligible cohort studies or randomized controlled trials (RCTs) from inception to January 2021 were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) for cardiovascular outcomes were calculated in the fixed- and random-effects model accordingly. Associated factors with risks of cardiovascular events were also studied in sensitivity analyses and metaregression analyses. Results. Compared with non-bDMARD users, the risks of myocardial infarction (MI) (, 95% CI, 0.63 to 0.87), heart failure (, 95% CI, 0.74 to 0.95), cardiovascular (CV) death (, 95% CI, 0.40 to 0.95), all-cause mortality (, 95% CI, 0.58 to 0.70), and 3P-MACE (composite endpoint of MI, stroke, and CV death) (, 95% CI, 0.53 to 0.89) were significantly reduced in bDMARD users, which were mainly driven by the risk reduction in patients with rheumatoid arthritis (RA). TNF-α inhibitors exhibited consistent benefits in reducing the risks of MI, heart failure, CV death, all-cause mortality, and 3P-MACE. Moreover, the risks of heart failure, CV death, all-cause mortality, and 3P-MACE were significantly reduced in bDMARD users with follow-up over one year. Conclusions. The use of bDMARDs might be associated with the reduced risks of CV events, especially in patients with RA. The CV events might be less frequent in bDMARD users with TNF-α inhibitors or follow-up over one year. More investigations are needed to validate conclusions.

中文翻译：

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改善生物疾病的抗风湿药物和心血管事件的风险：系统评价和荟萃分析

客观。评估使用改善生物疾病的抗风湿药物 (bDMARDs) 与全身炎症患者心血管事件风险之间的关联。方法。纳入了从开始到 2021 年 1 月的合格队列研究或随机对照试验 (RCT)。相应地，在固定效应和随机效应模型中计算了心血管结局的合并优势比 (OR) 和 95% 置信区间 (CI)。在敏感性分析和元回归分析中也研究了与心血管事件风险相关的因素。结果。与非 bDMARD 使用者相比，心肌梗死 (MI) 的风险 (, 95% CI, 0.63 to 0.87), 心力衰竭 (, 95% CI, 0.74 to 0.95), 心血管 (CV) 死亡 (, 95% CI, 0.40 to 0.95), 全因死亡率 (, 95% CI, 0.58 至 0.70) 和 3P-MACE (MI、卒中和 CV 死亡的复合终点) (, 95% CI, 0.53 to 0.89) 在 bDMARD 使用者中显着降低，这主要是由于类风湿关节炎 (RA) 患者的风险降低所致。TNF - α抑制剂在降低 MI、心力衰竭、CV 死亡、全因死亡率和 3P-MACE 风险方面表现出一致的益处。此外，经过一年以上的随访，bDMARD 使用者的心力衰竭、心血管死亡、全因死亡率和 3P-MACE 的风险显着降低。结论。bDMARDs 的使用可能与心血管事件风险的降低有关，尤其是在 RA 患者中。使用 TNF- α抑制剂或随访超过一年的 bDMARD 用户的 CV 事件可能不太常见需要更多的调查来验证结论。