Cardiovascular Risk of Conventional Synthetic, Biologic and Targeted Synthetic Disease-Modifying Antirheumatic Drugs in Common Rheumatic Diseases: A Narrative Review of Current Evidence.

@article{nian2026cardiovascular,
  title = {{Cardiovascular Risk of Conventional Synthetic, Biologic and Targeted Synthetic Disease-Modifying Antirheumatic Drugs in Common Rheumatic Diseases: A Narrative Review of Current Evidence.}},
  author = {Feige Nian and Zhehan Chen and Yezhou Qian and Mingfeng Yang and Bin Zhang},
  journal = {Therapeutics and clinical risk management},
  year = {2026},
  month = oct,
  doi = {10.2147/tcrm.s619254},
  url = {https://europepmc.org/article/MED/42959490},
  note = {CC BY-NC},
}

TY  - JOUR
TI  - Cardiovascular Risk of Conventional Synthetic, Biologic and Targeted Synthetic Disease-Modifying Antirheumatic Drugs in Common Rheumatic Diseases: A Narrative Review of Current Evidence.
AU  - Feige Nian
AU  - Zhehan Chen
AU  - Yezhou Qian
AU  - Mingfeng Yang
AU  - Bin Zhang
PY  - 2026
DA  - 2026/10/24
JO  - Therapeutics and clinical risk management
DO  - 10.2147/tcrm.s619254
UR  - https://europepmc.org/article/MED/42959490
AB  - Rheumatic diseases, including those with an autoimmune etiology (including rheumatoid arthritis, systemic lupus erythematosus, spondyloarthropathies and systemic vasculitis) represent an independent risk factor for coronary atherosclerosis and atherosclerotic cardiovascular disease (ASCVD). Systemic inflammation plays a multidimensional role in cardiovascular disease (CVD) pathogenesis, and patients with rheumatic diseases face elevated CVD risk and mortality compared with the general population, driven by both traditional cardiovascular risk factors and systemic immune dysregulation. Adequate management of inflammation will be accompanied by improved cardiovascular risk. In 2010, rheumatology introduced the "targeted therapy" strategy, and around the same time, cohort studies showed a significant decrease in cardiovascular mortality. A comprehensive literature search was conducted across PubMed, Embase, and the Cochrane Library from inception to June 2026. Studies were included if they evaluated the cardiovascular effects of disease-modifying antirheumatic drugs (DMARDs) in patients with the aforementioned rheumatic diseases. These diseases were selected based on their high prevalence, well-established cardiovascular risk, and availability of comparative evidence across DMARD classes; systemic sclerosis was excluded due to its distinct pathophysiology and limited published data on DMARD-related cardiovascular outcomes. We still need to deepen our understanding of the precise pathophysiological mechanism of autoimmune mediated acceleration of atherosclerosis and its clinical manifestations, to enable more appropriate selection of immunotherapies and biological agents for patients with rheumatic diseases, including those with an autoimmune etiology, and ultimately reduce the cardiovascular risk of this population, thereby improving prognosis and quality of life. The aim of this narrative review was to synthesize available evidence regarding the cardiovascular effects of three major classes of DMARDs: conventional synthetic disease‑modifying antirheumatic drugs (csDMARDs), biologic disease‑modifying antirheumatic drugs (bDMARDs), and targeted synthetic disease‑modifying antirheumatic drugs (tsDMARDs), across a stratified spectrum of cardiovascular endpoints ranging from hard clinical outcomes to subclinical surrogate markers. The main findings indicate that different DMARDs classes exhibit heterogeneous effects on cardiovascular outcomes, with csDMARDs such as methotrexate and hydroxychloroquine generally associated with favorable cardiovascular profiles, whereas the cardiovascular safety of certain biologic and targeted synthetic agents remains a subject of ongoing investigation. Limitations of this review include the observational nature of most included studies, heterogeneity across study designs and populations, and the lack of head-to-head randomized trials comparing different DMARDs classes with respect to cardiovascular outcomes. Collectively, these findings underscore the need for individualized cardiovascular risk assessment and tailored DMARDs selection in patients with rheumatic diseases, thereby optimizing both rheumatic and cardiovascular prognosis.
SN  - 1176-6336
SN  - 1178-203X
ER  -