Associations of obesity with modifiable risk factors for the development of cardiovascular disease in patients with rheumatoid arthritis
Antonios Stavropoulos-Kalinoglou 1*, Giorgos S Metsios 1, Vasileios F Panoulas 2, Karen M J Douglas 3, Alan M Nevill 1, Athanasios Z Jamurtas 4, Marina Kita 3, Yiannis Koutedakis 4 and George D Kitas 3
1 University of Wolverhampton, United Kingdom
2 Russells Hall Hospital, Dudley Group of Hospitals, NHS Trust, United Kingdom
3 Dudley Group of Hospitals, United Kingdom
4 Univeristy of Thessaly, Greece
* To whom correspondence should be addressed. E-mail: as{at}wlv.ac.uk.
Accepted 26 July 2008
 | Abstract |
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Objectives: To assess the associations 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 females) RA patients. 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=1.22-1.34); p=0.001), HDL (OR=1.10 (1.06-1.15); p=0.025), insulin resistance (OR= 1.13 (1.08-1.18); p=0.000) and the MetS (OR=1.15 (1.08-1.21); p=0.000). In multivariable analyses, BMI had the strongest associations with CVD risk factors (F1-354=8.663, p=0.000), and was followed by lipid-lowering treatment (F1-354=7.651, p=0.000), age (F1-354=7.541, p=0.000), antihypertensive treatment (F1-354=4.997, p=0.000) and gender (F1-354=4.707, p=0.000). Prevalence of hypertension (p=0.004), insulin resistance (p=0.005) and the MetS (p=0.000) was significantly different between normal, overweight and obese RA patients, 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 RA patients at increased CVD risk. Weight-loss regimes should be developed and applied in order to reduce CVD in RA patients.
