Influence of body mass index on cardiovascular risk in rheumatoid arthritis varies across anti-citrullinated protein antibody status and biologic use
Authors' conclusion
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.
Study context
- Population
- Patients with rheumatoid arthritis (RA) from an international observational cohort192 major adverse cardiovascular event (MACE)
- Participants
- 3,982 patients
- Exposure
- Association of body mass index (BMI) with cardiovascular risk across ACPA status and biologic use
- Outcome
- First MACE (MI, stroke or cardiovascular death); and all events (MACE, angina, revascularisation, transient ischaemic attack, peripheral arterial disease and HF)
Methodological detailsinternational observational cohort, multivariable Cox models stratified by centre risk, two- and three-way interaction analysis
- International observational cohort
- Multivariable Cox models stratified by centre risk
- Two- and three-way interaction analysis
Main finding
As reported in the abstract
MACE and all events per unit BMI, by ACPA status and biologic use
Estimate (95% CI)P value
ACPA-negative biologic usersvs non-users: not associated
HR (BMI, MACE) 0.38(0.25–0.57)
P < 0.001for interactionACPA-negative biologic usersvs non-users: not associated
HR (BMI, all events) 0.67(0.49–0.92)
p-for-interaction 0.012ACPA-positiveindependently of biologic use
HR (BMI, MACE) 1.04(1.01–1.07)
ACPA-positiveindependently of biologic use
HR (BMI, all events) 1.03(1.00–1.06)
Per unit BMI, as printed
- Three-way interaction BMI × ACPA × biologics on MACE
- P for interaction < 0.001
- Three-way interaction BMI × ACPA × biologics on all events
- P for interaction = 0.028
Observational data: associations, not effects.
Original publication
Influence of body mass index on cardiovascular risk in rheumatoid arthritis varies across anti-citrullinated protein antibody status and biologic use. RMD Open. Published 5 April 2025. doi:10.
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