Furthermore, among the four narrative reviews, one review explained the association between TNFi therapy and CHF, one review explained the systemic effects of interleukin-6 (IL-6) and its subsequent blockade leading to cardiovascular disease risk, one review narrated the mechanism behind increased levels of anticardiolipin antibodies with TNF-alpha blockade leading to increased CVD, and one review mentioned in detail the effect of using TNFi therapy on the mechanism of atherosclerosis. This evidence concerns the gene TNF and congestive heart failure.