CLINICAL AND EPIDEMIOLOGICAL RESEARCH

Associations of obesity with modifiable risk factors for the development of cardiovascular disease in patients with rheumatoid arthritis

A Stavropoulos-Kalinoglou^1,2,3, G S Metsios^1,2,3, V F Panoulas³, K M J Douglas³, A M Nevill^1,2, A Z Jamurtas^4,5, M Kita³, Y Koutedakis^1,4,5, G D Kitas^2,3,6

¹ School of Sport, Performing Arts & Leisure, Wolverhampton University, Walsall, UK
² Research Institute in Healthcare Science, University of Wolverhampton, Wolverhampton, UK
³ Department of Rheumatology, Dudley Group of Hospitals NHS Trust, Russell’s Hall Hospital, Dudley, UK
⁴ Department of Sport and Exercise Science, University of Thessaly, Trikala, Greece
⁵ Institute of Human Performance & Rehabilitation, Trikala, Greece
⁶ ARC Epidemiology Unit, University of Manchester, Manchester, UK

Antonios Stavropoulos-Kalinoglou, Department of Rheumatology, Russells Hall Hospital, Dudley Group of Hospitals NHS Trust, Dudley, West Midlands DY1 2HQ, UK; as{at}wlv.ac.uk

Objectives: To assess the association of body mass index (BMI) with modifiable cardiovascular disease (CVD) risk factors in patients with rheumatoid arthritis (RA).

Methods: BMI, disease activity, selected CVD risk factors and CVD medication were assessed in 378 (276 women) patients with RA. Patients exceeding accepted thresholds in 3 CVD risk factors were classified as having the metabolic syndrome (MetS).

Results: BMI independently associated with hypertension (OR = 1.28 (95% CI = 1.22 to 1.34); p = 0.001), high-density lipoprotein (OR = 1.10 (95% CI = 1.06 to 1.15); p = 0.025), insulin resistance (OR = 1.13 (95% CI = 1.08 to 1.18); p = 0.000) and MetS (OR = 1.15 (95% CI = 1.08 to 1.21); p = 0.000). In multivariable analyses, BMI had the strongest associations with CVD risk factors (F_1–354 = 8.663, p = 0.000), and this was followed by lipid-lowering treatment (F_1–354 = 7.651, p = 0.000), age (F_1–354 = 7.541, p = 0.000), antihypertensive treatment (F_1–354 = 4.997, p = 0.000) and gender (F_1–354 = 4.707, p = 0.000). Prevalence of hypertension (p = 0.004), insulin resistance (p = 0.005) and MetS (p = 0.000) was significantly different between patients with RA who were normal, overweight and obese, and BMI differed significantly according to the number of risk factors present (p = 0.000).

Conclusions: Increasing BMI associates with increased CVD risk independently of many confounders. RA-specific BMI cut-off points better identify patients with RA at increased CVD risk. Weight-loss regimens should be developed and applied in order to reduce CVD in patients with RA.

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