The aim of this cohort study was to determine the risk of acute coronary syndromes (ACS) in patients with early rheumatoid arthritis (RA) in relation to treatment with, and response to, anti-TNF, since data in this area are lacking.

The Swedish Rheumatology Register was used to identify a cohort of patients with RA (n=6,000) and the risk of first occurrence of an ACS was compared between patients treated with anti-TNF (5,969 anti-TNF–exposed person-years) and those without exposure to anti-TNF (17,467 unexposed person-years of follow up).

In a nested case–control study (24 cases and 81 controls), the relationship between response to anti-TNF according to the European League Against Rheumatism (EULAR) response criteria and the risk of ACS was investigated.

In the cohort study, treatment with anti-TNF was not associated with any statistically significant alteration in the risk of ACS (HR 0.80, 95% confidence interval [95% CI] 0.52–1.24).

In the nested case–control study, a good or moderate EULAR treatment response at three months and at six months was not associated with a risk of ACS (odds ratio [OR] 1.7, 95% CI 0.5–5.1 and OR 1.5, 95% CI 0.3–6.9, respectively), when adjusted for disease activity before treatment start.

The researchers concluded that in this study of patients treated with anti-TNF within the first years of RA, neither treatment with, nor response to, anti-TNF therapy could be linked to any statistically significant decrease in the risk of ACS.