Conventional Disease-modifying Antirheumatic Drugs (dmards)
In individuals with rheumatologic diseases, the risk of
cardiovascular disease (CVD) is increased due to systemic inflammation,
traditional cardiovascular risk factors, reduced physical activity, and the
potential adverse effects of antirheumatic treatments. Conventional
disease-modifying antirheumatic drugs (DMARDs) such as methotrexate,
leflunomide, sulfasalazine, and hydroxychloroquine play a crucial role in
disease control and can directly influence cardiovascular outcomes. For example,
although methotrexate has raised concerns due to its potential to cause
hyperhomocysteinemia, this adverse effect can be prevented with folate
supplementation, and methotrexate has been shown to reduce cardiovascular
mortality through anti-inflammatory, antioxidative, and metabolic mechanisms.
Leflunomide exhibits both anti-inflammatory and cardioprotective effects, but
may cause an early increase in blood pressure. Sulfasalazine presents a neutral
cardiovascular profile, with potential indirect benefits by reducing vascular
inflammation. Hydroxychloroquine may lower CVD risk by improving lipid and
glucose metabolism; however, rare but serious adverse effects such as
cardiomyopathy and QT prolongation have been reported. Other
immunosuppressants, including azathioprine, cyclophosphamide, and calcineurin
inhibitors, may increase CVD risk through mechanisms such as endothelial
dysfunction and hypertension. In conclusion, conventional DMARDs may exert
beneficial effects on CVD by controlling inflammation; however, careful
monitoring and individualized risk assessment are essential due to potential
adverse effects.
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