TOPLINE:
Body mass index (BMI) influenced cardiovascular risk in rheumatoid arthritis (RA), with the effects varying according to anti–citrullinated protein antibody (ACPA) status and use of biologics. BMI was inversely associated with lower cardiovascular risk in ACPA-negative patients on biologics.
METHODOLOGY:
- Researchers evaluated 3982 patients with RA without cardiovascular disease (age at enrollment, 18-85 years; 73.7% women) from 13 centers across 10 countries to explore the association between BMI and cardiovascular risk while considering the effect of antibody status and biologic use.
- Patients were stratified by their ACPA status and use of biologic disease-modifying antirheumatic drugs (bDMARDs) if they received monotherapy or a combination therapy with conventional synthetic DMARDs.
- Two composite clinical outcomes were the first major adverse cardiovascular event (MACE), defined as nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death, and any first cardiovascular event beyond MACE, including angina and heart failure.
- The effect of BMI, ACPA status, and bDMARD use on the risk for cardiovascular outcomes was assessed over a mean follow-up duration of 5.8 years.
TAKEAWAY:
- A total of 192 first MACE and 319 first total events occurred, with crude incidence rates of 8.32 and 14.01 per 1000 patient-years, respectively. The main effects of BMI, ACPA status, or bDMARD use were not significant for cardiovascular outcomes.
- In ACPA-positive patients, BMI was associated with the risk for MACE (hazard ratio [HR], 1.04; P = .018), but this association was not noted in ACPA-negative patients.
- A significant three-way interaction between BMI, bDMARD use, and ACPA status was observed for both MACE (P for interaction = .001) and all cardiovascular events (P for interaction = .029).
- BMI was inversely associated with the risk for MACE (adjusted HR, 0.36; P < .001) and all cardiovascular events (adjusted HR, 0.67; P = .013) in ACPA-negative patients using bDMARDs but not in nonusers. In ACPA-positive patients, the bDMARD-BMI interaction was not significant for either outcome.
IN PRACTICE:
“Our findings may have clinical implications on individual patient care,” the authors wrote. “Implementation of imaging modalities that accurately characterize body composition may help characterize the individual contributions of lean and fat mass in the aforementioned scenarios and illuminate the nuanced relationship of adipose tissue volume, distribution, and inflammation with cardiovascular risk,” they added.
SOURCE:
This study was led by George Athanasios Karpouzas, MD, The Lundquist Institute, Torrance, California. It was published online on April 5, 2025, in RMD Open.
LIMITATIONS:
This study’s findings may have been affected by residual confounding from unmeasured variables and differences in the follow-up time. Recruitment through academic and referral centers may have introduced referral bias owing to more aggressive risk factor management. Additionally, collection of data on the characteristics of RA, cardiovascular risk factors, and medication use only at baseline limited the analysis of time-varying effects.
DISCLOSURES:
This study was supported by Pfizer through an investigator-initiated grant, but the company was not involved in this study design, study-related procedures, data collection, data analysis or interpretation, manuscript drafting, or manuscript submission. No relevant conflicts of interest were disclosed by the authors.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.