Effect of BMI on Cardiovascular Risk in Rheumatoid Arthritis Varies by Antibody Status and Biologic Use

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.

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.

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