Evidence map›Paper›PMID 40187772›Full record

Observational studyRMD open2025

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

George Athanasios Karpouzas, Miguel A Gonzalez-Gay, Alfonso Corrales, Elena Myasoedova, Solbritt Rantapää-Dahlqvist, Petros P Sfikakis, Patrick Dessein, Carol Hitchon, Virginia Pascual-Ramos, Irazú Contreras-Yáñez and 12 more

Abstract readObservational Study
In one paragraph

Observational study in RMD open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 5 papers.

0numbers the graph read from it
0cells of the map it votes in
5citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

5 citing papers in PubMed.

  1. Article
  2. Observational
  3. Review
  4. Review
  5. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

22 authors.

George Athanasios KarpouzasThe Lundquist Institute, Torrance, California, USA gkarpouzas@lundquist.org.ORCID 0000-0003-1065-1563
Miguel A Gonzalez-GayMedicine, University of Cantabria, Santander, Spain.ORCID 0000-0002-7924-7406
Alfonso CorralesHospital Universitario Marques de Valdecilla, Santander, Spain.
Elena MyasoedovaRheumatology, Mayo Clinic, Rochester, Minnesota, USA.ORCID 0000-0003-2006-1436
Solbritt Rantapää-DahlqvistDepartment of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden.ORCID 0000-0001-8259-3863
Petros P Sfikakis1st Department of Propaedeutic and Internal Medicine, Laiko Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Patrick DesseinMedicine and Physiology, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa.ORCID 0009-0008-3092-9474
Carol HitchonUniversity of Manitoba, Winnipeg, Manitoba, Canada.
Virginia Pascual-RamosImmunology and Rheumatology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.ORCID 0000-0002-7368-498X
Irazú Contreras-YáñezImmunology and Rheumatology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico.
Iris J Colunga-PedrazaRheumatology, Hospital Universitario UANL, Monterrey, Mexico.ORCID 0000-0002-2786-5843
Dionicio Angel Galarza-DelgadoRheumatology, Hospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Mexico.ORCID 0000-0001-9714-2109
Jose Ramon Azpiri-LopezHospital Universitario Dr Jose Eleuterio Gonzalez, Monterrey, Mexico.
Anne Grete SembRheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.ORCID 0000-0003-2730-2853
Piet Leonardus Cornelis Maria van RielIQ healthcare, Radboud Universiteit, Nijmegen, The Netherlands.
Durga Prasanna MisraClinical Immunology and Rheumatology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.ORCID 0000-0002-5035-7396
Durez PatrickCliniques universitaires Saint-Luc, Bruxelles, Belgium.
Brian Bridal LogstrupAarhus Universitet, Aarhus, Central Denmark Region, Denmark.
Ellen-Margrethe HaugeDepartment of Rheumatology, Aarhus University Hospital Skejby, Aarhus, Denmark.
George KitasThe Dudley Group NHS Foundation Trust, Dudley, UK.
Sarah R OrmsethHarbor-UCLA Medical Center, Torrance, California, USA.
for An inTernationAl Cardiovascular Consortium for Rheumatoid Arthritis (ATACC-RA)

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectivesThe 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.

methodsWe 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.

resultsWe 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.

conclusionsBMI 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.

Indexed as

Anti-Citrullinated Protein AntibodiesArthritis, RheumatoidBiological ProductsBody Mass IndexCardiovascular DiseasesAgedFemaleHeart Disease Risk FactorsHumansMaleMiddle AgedRisk FactorsAnti-Citrullinated Protein AntibodiesBiological ProductsAnti-Citrullinated Protein AntibodiesArthritis, RheumatoidBiological TherapyCardiovascular Diseases

Identifiers

PMID40187772
PMCPMC11973786

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.