体重指数对类风湿关节炎患者心血管风险的影响因抗瓜氨酸化蛋白抗体状态和生物制剂使用情况而异。

Influence of body mass index on cardiovascular risk in rheumatoid arthritis varies across anti-citrullinated protein antibody status and biologic use.

作者信息

Karpouzas George Athanasios, Gonzalez-Gay Miguel A, Corrales Alfonso, Myasoedova Elena, Rantapää-Dahlqvist Solbritt, Sfikakis Petros P, Dessein Patrick, Hitchon Carol, Pascual-Ramos Virginia, Contreras-Yáñez Irazú, Colunga-Pedraza Iris J, Galarza-Delgado Dionicio Angel, Azpiri-Lopez Jose Ramon, Semb Anne Grete, van Riel Piet Leonardus Cornelis Maria, Misra Durga Prasanna, Patrick Durez, Bridal Logstrup Brian, Hauge Ellen-Margrethe, Kitas George, Ormseth Sarah R

机构信息

The Lundquist Institute, Torrance, California, USA

Harbor-UCLA Medical Center, Torrance, California, USA.

出版信息

RMD Open. 2025 Apr 5;11(2):e005464. doi: 10.1136/rmdopen-2025-005464.

DOI:10.1136/rmdopen-2025-005464

PMID:40187772

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11973786/

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.

摘要

目的

体重指数（BMI）对类风湿关节炎（RA）患者心血管风险的影响尚不清楚。RA的特征可能会影响BMI与风险之间的关联。疾病活动可预测心血管风险，仅在抗瓜氨酸化抗体（ACPA）阳性患者中与肥胖相关。生物制剂可改变身体组成并降低RA患者的心血管风险。我们探讨了BMI与心血管风险之间的关联，以及这种关联在ACPA状态和生物制剂使用情况方面是否存在差异。

方法

我们评估了来自一个国际观察性队列的3982例患者。结局包括：（a）首次发生的主要不良心血管事件（MACE），包括心肌梗死、中风或心血管死亡；（b）所有事件，包括MACE、心绞痛、血运重建、短暂性脑缺血发作、外周动脉疾病和心力衰竭。通过中心风险分层的多变量Cox模型评估BMI、ACPA、生物制剂及其双向和三向交互作用对结局的影响。

结果

我们记录了192例MACE和319例所有事件。未观察到BMI、ACPA或生物制剂的主要效应。注意到它们在MACE（交互作用P<0.001）和所有事件（交互作用P=0.028）上存在三向交互作用。在ACPA阴性患者中，在使用生物制剂的患者中，BMI与MACE（风险比[HR]0.38（95%可信区间[CI]0.25至0.57））和所有事件（HR 0.67（0.49至0.92））呈负相关，但在未使用生物制剂的患者中并非如此（交互作用P<0.001和0.012）。在ACPA阳性患者中，无论是否使用生物制剂，BMI均与MACE（HR 1.04[1.01 - 1.07]）和所有事件（HR 1.03（1.00至1.06））相关。