Cardiovascular Safety of Biologics and JAK Inhibitors in Patients with Rheumatoid Arthritis

Curr Rheumatol Rep. 2018 May 30;20(7):42. doi: 10.1007/s11926-018-0752-2.


Purpose of review: Increased cardiovascular (CV) risk and associated mortality in rheumatoid arthritis (RA) are not fully explained by traditional CV risk factors. This review discusses the epidemiology and mechanisms of increased CV risk in RA and treatment effects on CV risk focusing on biologic disease-modifying anti-rheumatic drugs (DMARDs) and JAK inhibitors.

Recent findings: Intermediary metabolic changes by inflammatory cytokines are observed in body composition, lipid profile, and insulin sensitivity of RA patients, leading to accelerated atherosclerosis and increased CV risk. Successful treatment with DMARDs has shown beneficial effects on these metabolic changes and ultimately CV outcomes, in proportion to the treatment efficacy in general but also with drug-specific mechanisms. Recent data provide further information on comparative CV safety between biologic DMARDs or JAK inhibitors as well as their safety signals for non-atherosclerotic CV events. CV benefits or safety signals associated with DMARD treatments can differ despite similar drug efficacy against RA, suggesting that both anti-inflammatory and drug-specific mechanisms are involved in altering CV risk.

Keywords: Biologic; Cardiovascular; JAK inhibitor; Rheumatoid arthritis.

Publication types

  • Review

MeSH terms

  • Antirheumatic Agents / pharmacology
  • Antirheumatic Agents / therapeutic use*
  • Arthritis, Rheumatoid / complications
  • Arthritis, Rheumatoid / drug therapy*
  • Arthritis, Rheumatoid / epidemiology
  • Biological Products / pharmacology
  • Biological Products / therapeutic use*
  • Body Composition / drug effects
  • Body Composition / physiology
  • Cardiovascular Diseases / epidemiology
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / prevention & control*
  • Humans
  • Insulin Resistance / physiology
  • Janus Kinase Inhibitors / pharmacology
  • Janus Kinase Inhibitors / therapeutic use*
  • Lipids / blood
  • Risk Factors


  • Antirheumatic Agents
  • Biological Products
  • Janus Kinase Inhibitors
  • Lipids