Zotova LA, Enenkov NV. From joints to vessels: How rheumatoid arthritis therapy alters the fate of the heart. World J Cardiol 2025; 17(9): 109876 [DOI: 10.4330/wjc.v17.i9.109876]
Corresponding Author of This Article
Liudmila A Zotova, PhD, Assistant Professor, Department of Hospital Therapy with a Course of Medical and Social Expertise, The Federal State Budgetary Educational Institution of Higher Education “Ryazan State Medical University named after Academician I.P. Pavlov” of the Ministry of Health of the Russian Federation, Stroikova, 96, Ryazan 390026, Ryazanskaya Oblast’, Russia. dr.zotova@gmail.com
Research Domain of This Article
Rheumatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Cardiol. Sep 26, 2025; 17(9): 109876 Published online Sep 26, 2025. doi: 10.4330/wjc.v17.i9.109876
From joints to vessels: How rheumatoid arthritis therapy alters the fate of the heart
Liudmila A Zotova, Nikita V Enenkov
Liudmila A Zotova, Nikita V Enenkov, Department of Hospital Therapy with a Course of Medical and Social Expertise, The Federal State Budgetary Educational Institution of Higher Education “Ryazan State Medical University named after Academician I.P. Pavlov” of the Ministry of Health of the Russian Federation, Ryazan 390026, Ryazanskaya Oblast’, Russia
Author contributions: Zotova LA: Conceptualization, investigation, writing-original draft, writing- review & editing, visualization, validation, formal analysis; Enenkov NV: Formal analysis, writing-original draft. All authors have read and approved the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Liudmila A Zotova, PhD, Assistant Professor, Department of Hospital Therapy with a Course of Medical and Social Expertise, The Federal State Budgetary Educational Institution of Higher Education “Ryazan State Medical University named after Academician I.P. Pavlov” of the Ministry of Health of the Russian Federation, Stroikova, 96, Ryazan 390026, Ryazanskaya Oblast’, Russia. dr.zotova@gmail.com
Received: May 26, 2025 Revised: June 12, 2025 Accepted: August 28, 2025 Published online: September 26, 2025 Processing time: 116 Days and 6.5 Hours
Abstract
Rheumatoid arthritis (RA) significantly increases the risk of cardiovascular diseases (CVD), including myocardial infarction (MI), stroke, and heart failure (HF). This association is linked to chronic inflammation, endothelial dysfunction, and accelerated atherosclerosis. Patients with RA have a 1.5-2 times higher risk of CVD compared to the general population, and cardiovascular mortality reaches 40%-50%. However, basic anti-inflammatory drugs such as methotrexate reduce the rate of cardiovascular events by 20%-30% due to suppression of systemic inflammation. Biological medications also demonstrate a cardioprotective effect, reducing the risk of MI by 20%-40%, although some (e.g., tumor necrosis factor α inhibitors) may increase the risk of HF in predisposed patients. Janus kinase inhibitors are associated with an increased risk of thrombosis and cardiovascular events, particularly in patients with pre-existing risk factors. Therefore, optimal control of inflammation in RA can reduce cardiovascular risk; however, drug selection should consider individual safety profiles. Regular monitoring of cardiovascular risk factors and a multidisciplinary approach are key to managing patients with RA and minimizing complications.
Core Tip: In this review, we analyze both the positive and negative influences on the cardiovascular system of all drugs currently used in rheumatological practice, including the most up-to-date therapies. Particular attention is given to the safety analysis of long-established drugs, whose effectiveness in treating rheumatoid arthritis is well established, while their cardiovascular safety has been studied to a much lesser extent.
