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The normalization of fibrinogen and thrombocytosis and the reduction of the expression of vascular endothelial growth factor, as well as of oxidative stress and endothelial dysfunction, by TNF-α inhibitors may reduce the relevant risk factors for atherosclerosis and cardiovascular events in patients with chronic inflammatory disease and increased cardiovascular risk, such as in RA [25,45,52,53,54]

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Even though most of the studies were RCTs, there was heterogeneity in glutamine supplementation dosing, formulation, timing, and duration, which limits the strength of available conclusions