@article{10902/36842,
year = {2025},
url = {https://hdl.handle.net/10902/36842},
abstract = {Objectives: The impact of body mass index (BMI) on cardiovascular risk in rheumatoid arthritis (RA) is unclear. RA characteristics may influence the association between BMI and risk. Disease activity, which predicts cardiovascular risk, is associated with obesity only among anticitrullinated antibody (ACPA)-positive patients. Biologics alter body composition and mitigate cardiovascular risk in RA. We explored the association of BMI with cardiovascular risk and whether this varied across ACPA status and biologic use.
Methods: We evaluated 3982 patients from an international observational cohort. Outcomes included (a) first major adverse cardiovascular event (MACE) encompassing myocardial infarction, stroke or cardiovascular death; and (b) all events comprising MACE, angina, revascularisation, transient ischaemic attack, peripheral arterial disease and heart failure. Multivariable Cox models stratified by centre risk evaluated the impact of BMI, ACPA, biologics and their two- and three-way interactions on outcomes.
Results: We recorded 192 MACE and 319 total events. No main effects of BMI, ACPA or biologics were observed. A three-way interaction between them on MACE (p-interaction<0.001) and all events (p-interaction=0.028) was noted. Among ACPA negative patients, BMI was inversely associated with MACE (HR 0.38 (95% CI 0.25 to 0.57)) and all events (HR 0.67 (0.49 to 0.92)) in biologic users but not non-users (p-for-interaction <0.001 and 0.012). Among ACPA-positive patients, BMI was associated with MACE (HR 1.04 [1.01-1.07]) and all events (HR 1.03 (1.00 to 1.06)) independently of biologic use.
Conclusions: BMI is inversely associated with cardiovascular risk only among ACPA-negative biologic users. In contrast, BMI is associated with cardiovascular risk in ACPA-positive patients independently of biologic use.},
organization = {This work was supported by Pfizer through an investigator-initiated
grant award (grant ID number 68633259) to GAK. The sponsors were
not involved in the study design, study-related
procedures, data collection, data
analysis or interpretation, manuscript drafting or manuscript submission.},
publisher = {BMJ Publishing Group},
publisher = {RMD Open, 2025, 11, e005464},
title = {Influence of body mass index on cardiovascular risk in rheumatoid arthritis varies across anti-citrullinated protein antibody status and biologic use},
author = {Karpouzas, George Athanasios and González-Gay Mantecón, Miguel Ángel and Corrales Martínez, Alfonso and Myasoedova, Elena and Rantapää-Dahlqvist, Solbritt and Sfikakis, Petros P. and Dessein, Patrick and Hitchon, Carol and Pascual-Ramos, Virginia and Contretas-Yáñez, Irazú and Colunga-Pedraza, Iris J. and Galarza-Delgado, Dionicio Ángel and Azpiri-López, José Ramón and Grete Semb, Anne and Van Riel, Piet Leonardus Cornelis Maria and Misra, Durga Prasanna and Patrick, Durez and Lagstrup, Brian Bridal and Hauge, Ellen-Margrethe and Kitas, George},
}