{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T08:44:55Z","timestamp":1792226695240,"version":"4.4.0"},"reference-count":42,"publisher":"The Journal of Rheumatology","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2021,5]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To examine the comparative effects of biologic disease-modifying antirheumatic drugs (bDMARD) and tofacitinib against conventional synthetic DMARD (csDMARD) on incident cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>RA patients with \u2265 1 year of participation in the FORWARD study, from 1998 through 2017, were assessed for incident composite CVD events (myocardial infarction, stroke, heart failure, and CVD-related death validated from hospital\/death records). DMARD were categorized into 7 mutually exclusive groups: (1) csDMARD-referent; (2) tumor necrosis factor-\u03b1 inhibitor (TNFi); (3) abatacept (ABA); (4) rituximab; (5) tocilizumab; (6) anakinra; and (7) tofacitinib. Glucocorticoids (GC) were assessed using a weighted cumulative exposure model, which combines information about duration, intensity, and timing of exposure into a summary measure by using the weighted sum of past oral doses (prednisolone equivalent). Cox proportional hazard models were used to adjust for confounders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During median (IQR) 4.0 (1.7\u20138.0) years of follow-up, 1801 CVD events were identified in 18,754 RA patients. The adjusted model showed CVD risk reduction with TNFi (HR 0.81, 95% CI 0.71\u20130.93) and ABA (HR 0.50, 95% CI 0.30\u20130.83) compared to csDMARD. While higher GC exposure as weighted cumulative exposure was associated with increased CVD risk (HR 1.15, 95% CI 1.11\u20131.19), methotrexate (MTX) use was associated with CVD risk reduction [use vs nonuse HR 0.82, 95% CI 0.74\u20130.90, and high dose (&gt; 15 mg\/week) vs low dose (\u2264 15 mg\/week) HR 0.83, 95% CI 0.70\u20130.99].<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>ABA and TNFi were associated with decreased risk of CVD compared to csDMARD. Minimizing GC use and optimizing MTX dose may improve cardiovascular outcomes in patients with RA.<\/jats:p><\/jats:sec>","DOI":"10.3899\/jrheum.200265","type":"journal-article","created":{"date-parts":[[2020,8,15]],"date-time":"2020-08-15T16:20:16Z","timestamp":1597508416000},"page":"648-655","source":"Crossref","is-referenced-by-count":89,"title":["The Risk of Cardiovascular Events Associated With Disease-modifying Antirheumatic Drugs in Rheumatoid Arthritis"],"prefix":"10.3899","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5423-393X","authenticated-orcid":false,"given":"Gulsen","family":"Ozen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia","family":"Pedro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5350-3934","authenticated-orcid":false,"given":"Kaleb","family":"Michaud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2262","published-online":{"date-parts":[[2020,8,15]]},"reference":[{"key":"2022062303401366000_48.5.648.1","first-page":"S35","article-title":"Mortality in rheumatoid arthritis: 2008 update","volume":"26","author":"Sokka","year":"2008","journal-title":"Clin Exp Rheumatol"},{"key":"2022062303401366000_48.5.648.2","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2011-200726"},{"key":"2022062303401366000_48.5.648.3","doi-asserted-by":"publisher","DOI":"10.1038\/nrrheum.2015.40"},{"key":"2022062303401366000_48.5.648.4","doi-asserted-by":"crossref","first-page":"1449","DOI":"10.1002\/art.39098","article-title":"Disease activity in rheumatoid arthritis and the risk of cardiovascular events","volume":"67","author":"Solomon","year":"2015","journal-title":"Arthritis Rheumatol"},{"key":"2022062303401366000_48.5.648.5","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2017-211727"},{"key":"2022062303401366000_48.5.648.6","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-204933"},{"key":"2022062303401366000_48.5.648.7","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-209954"},{"key":"2022062303401366000_48.5.648.8","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-206624"},{"key":"2022062303401366000_48.5.648.9","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0087965"},{"key":"2022062303401366000_48.5.648.10","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.001267"},{"key":"2022062303401366000_48.5.648.11","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.110340"},{"key":"2022062303401366000_48.5.648.12","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.170926"},{"key":"2022062303401366000_48.5.648.13","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.117.007393"},{"key":"2022062303401366000_48.5.648.14","doi-asserted-by":"crossref","first-page":"1154","DOI":"10.1002\/art.40084","article-title":"Cardiovascular safety of tocilizumab versus tumor necrosis factor inhibitors in patients with rheumatoid arthritis: a multi-database cohort study","volume":"69","author":"Kim","year":"2017","journal-title":"Arthritis Rheumatol"},{"key":"2022062303401366000_48.5.648.15","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1016\/j.semarthrit.2018.03.012","article-title":"No difference in cardiovascular risk of tocilizumab versus abatacept for rheumatoid arthritis: A multi-database cohort study","volume":"48","author":"Kim","year":"2018","journal-title":"Semin Arthritis Rheum"},{"key":"2022062303401366000_48.5.648.16","doi-asserted-by":"crossref","first-page":"1004","DOI":"10.1002\/acr.23737","article-title":"Tocilizumab and the risk for cardiovascular disease: a direct comparison among biologic disease-modifying antirheumatic drugs for rheumatoid arthritis patients","volume":"71","author":"Xie","year":"2019","journal-title":"Arthritis Care Res"},{"key":"2022062303401366000_48.5.648.17","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2015-207870"},{"key":"2022062303401366000_48.5.648.18","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1707914"},{"key":"2022062303401366000_48.5.648.19","doi-asserted-by":"crossref","unstructured":"Mertens M , Singh JA. 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