Weight fluctuation increases risk for cardiovascular events in patients with RA
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Recent weight changes, as well as high variability in weight, predict cardiovascular events in patients with rheumatoid arthritis, according to data published in Arthritis Care & Research.
“As rheumatologists, we often observe fluctuations in weight among our patients,” Joshua F. Baker, MD, MSCE, of the University of Pennsylvania and the Philadelphia Veterans Affairs Medical Center, told Healio Rheumatology. “However, we don't have a lot of data to support whether we should be worried about these fluctuations, whether they might signal adverse metabolic health, or what to do about them.”
To examine whether changes in weight were independently predictive of cardiovascular events among patients with RA, Baker and colleagues studied data from the Corrona registry. Initiated in 2001, this registry is the largest independent database in North America collecting data from both rheumatologists and patients at the time of a clinical encounter every 3 to 6 months, according to the researchers. For their study, Baker and colleagues included all 31,381 participants enrolled through February 2017.
The researchers categorized weight changes into one of five groups: a loss of 10% or more, a loss of 5% to 10%, stable, a gain of 5% to 10%, or a gain of 10% or more. In addition, they organized patients by quintile of variability in weight in prior observation periods. Lastly, the researchers used Cox proportional hazard models to analyze independent associations between timevarying weight change and weight variability, and risk of CV events, before and after adjusting for cardiovascular risk factors, RA disease features and disability.
According to the researchers, included participants who lost or gained 10% of their weight demonstrated greater disease activity, worse physical function and were more likely to smoke, have diabetes, use corticosteroids and be disabled. In their adjusted models, Baker and colleagues noted a greater risk for cardiovascular events among those who demonstrated a 10% weight loss (HR = 1.18; 1.03-1.36) or weight gain (HR = 1.2; 1.04-1.38).
In addition, the association between weight change and cardiovascular events was stronger among patients with a BMI of less than 25 kg/m2 for 10% weight loss (HR = 1.34; 1.08-1.66) and 10% weight gain (HR = 1.74; 1.41-2.24). Participants who demonstrated a greater variability in weight also had a higher risk for cardiovascular events.
“The key findings of the study are that fluctuations in weight are frequently observed among patients with more severe and longstanding disease, disability and smoking,” Baker said. “Fluctuating weight was associated with a greater risk of cardiovascular events, independent of a variety of other factors, as has been observed in other settings. This was particularly true among thinner patients.”
“It remains unclear whether fluctuations in weight are simply a bad sign or whether they convey something about the patient’s metabolism that is important in the development of cardiovascular disease,” he added. “Either way, these data support closer attention to thin patients who have had recent fluctuations in their weight. It may also be important to point out that it is likely that these weight fluctuations are unintentional. We don't know whether intentional changes in weight due to dieting would have a similar association.”
Perspective
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Douglas B. Smith, MD
The study by Baker and colleagues identifies another measurable risk factor for CV events in RA patients, extremes of weight change. While unexpected, changes of >10% weight gain or loss, predicted increased CV risk in those RA patients participating in the Corrona database.
In my practice, I find many patients tinkering with diet, searching for “natural remedies” for inflammation control. Sometimes the diets are rather extreme, resulting in rapid/drastic weight loss. Based on the findings in the article, I will need to be mindful that dietary changes may have unexpected results. In this case, more moderation will be necessary.
In contrast, I live in a state that ranks high for obesity, where significant portions of the population needs some type of drastic weight loss. We have all seen those with degenerative back, hip or knee disease who have become much more active due to reduction in weight. I wonder if this risk observation is true of non-inflammatory arthritis patients. For now, I am stressing the need to get to normal BMI if possible.
CV risk reduction is a goal of rheumatologists caring for our rheumatic disease patients. I have been considering assigning my nurse practitioner to be the point of contact once a year to meet with RA and SLE patients to review their CV risk profile. Weight change will need to be added to the list of other independent CV risk factors.
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