Axial spondyloarthritis (axSpA) is associated with an increased risk of cardiovascular disease. We aimed to evaluate the effect of tumor necrosis factor inhibitors (TNFis) on the risk of cardiovascular disease in patients with axSpA. This retrospective study included 450 patients with axSpA without pre-existing cardiovascular disease. The outcome was incident cardiovascular disease (myocardial infarction or stroke) after the diagnosis of axSpA. The effect of TNFis on cardiovascular risk was analyzed in the total study population and in an inverse probability of treatment weighting (IPTW)-adjusted population. Cox proportional hazards models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (95% CIs) for cardiovascular disease, according to exposure to TNFis. Of the 450 patients, 233 (51.8%) and 217 (48.2%) patients were and were not exposed to TNFis, respectively. Twenty cardiovascular diseases occurred during 2868 person-years of follow-up (incidence rate: 6.97/1000 person-years). In the total study population, exposure to TNFis was associated with a reduced cardiovascular risk when adjusted for traditional cardiovascular risk factors (HR 0.30, 95% CI 0.10–0.85, p = 0.024). However, when time-averaged erythrocyte sedimentation rate and C-reactive protein were additionally adjusted, this association was attenuated and lost statistical significance (HR 0.37, 95% CI 0.12–1.12, p = 0.077). Furthermore, in the IPTW-adjusted population, exposure to TNFis showed no significant reduction in cardiovascular risk (HR 0.60, 95% CI 0.23–1.54, p = 0.287). Although controlling inflammation through TNFis could be beneficial in cardiovascular risk reduction, our data indicate no TNFi-specific reduction in cardiovascular risk in patients with axSpA.

中文翻译：

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肿瘤坏死因子抑制剂对中轴型脊柱关节炎患者心血管疾病风险的影响


中轴型脊柱关节炎 (axSpA) 与心血管疾病风险增加相关。我们的目的是评估肿瘤坏死因子抑制剂 (TNFis) 对 axSpA 患者心血管疾病风险的影响。这项回顾性研究纳入了 450 名未患有心血管疾病的 axSpA 患者。结果是诊断 axSpA 后发生心血管疾病（心肌梗死或中风）。在整个研究人群和治疗权重逆概率 (IPTW) 调整人群中分析了 TNFis 对心血管风险的影响。根据 TNFis 的暴露情况，使用 Cox 比例风险模型来估计心血管疾病的风险比 (HR) 和 95% 置信区间 (95% CI)。在 450 名患者中，分别有 233 名 (51.8%) 和 217 名 (48.2%) 患者暴露于 TNF 和未暴露于 TNF。 2868人年随访期间，出现20种心血管疾病（发病率：6.97/1000人年）。在整个研究人群中，根据传统心血管危险因素进行调整后，暴露于 TNFis 与心血管风险降低相关（HR 0.30，95% CI 0.10-0.85，p = 0.024）。然而，当额外调整时间平均红细胞沉降率和 C 反应蛋白时，这种相关性减弱并失去统计学意义（HR 0.37，95% CI 0.12-1.12，p = 0.077）。此外，在经过IPTW调整的人群中，暴露于TNFis并没有显着降低心血管风险（HR 0.60，95% CI 0.23-1.54，p = 0.287）。尽管通过 TNFi 控制炎症可能有益于降低心血管风险，但我们的数据表明 TNFi 并不能特异性降低 axSpA 患者的心血管风险。