Effects of TNF alpha inhibitors on adiposity and other cardiovascular risk factors: implications for the cardiovascular prognosis in patients with rheumatoid arthritis

Introduction: Rheumatoid arthritis (RA) is a chronic inflammatory disease that is associated with increased cardiovascular (CV) morbidity and mortality. This increased CV burden is the result of an enhanced prevalence of traditional CV risk factors, the effects of treatments given for RA but also systemic inflammation. In this setting, the control of inflammation by the current therapeutic approach may improve the overall CV prognosis of RA. Areas covered: This paper analyses the impact of TNF alpha inhibitors on the different CV risk factors with a special emphasis on lipid profile and body composition. The lipid profile under TNF alpha inhibitors changes, an increase in total and high density lipoprotein (HDL) cholesterol is observed but the atherogenic index and low density lioprotein cholesterol are unaffected. In parallel, TNF alpha inhibitors induce an accumulation of fat in the abdominal/visceral region. Analysis of cohort and registry studies indicates that CV events are reduced under this treatment. Expert opinion: Overall, the favourable CV effect under TNF alpha inhibitors does not seem to be explained by the changes in traditional CV risk factors, but rather by the improvement in systemic inflammation. Alternatively, the changes in body composition raise the question of their effect on long-term CV safety.