Comprehensive Risk Factor Control Attenuates Excess Cardiovascular Risk in Rheumatoid Arthritis: A Prospective Cohort Study
In brief
High risk-factor control halves cardiovascular risk in rheumatoid arthritis
In a UK Biobank cohort of 4,426 RA patients, those achieving high control of nine lifestyle and clinical risk factors experienced a 54% lower risk of cardiovascular disease compared with low control, gaining about 3.6 extra CVD-free years. The benefit persisted even among patients with high genetic risk, suggesting comprehensive prevention can offset the excess CVD burden in RA.
- Journal
- European journal of preventive cardiology (Q1)
- Published
- 5 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Hongxuan Fan, Xiaoyu Zi, Tianjiao Li, Boda Zhou, Caihong Wang, Lei Liu
- PMID
- 42698343
- DOI
- 10.1093/eurjpc/zwag467
Why clinicians should know about it
- Picked for Rheumatology (top studies of the week, 6 September 2026): Prospective cohort linking risk factor control to CVD outcomes
Abstract
OBJECTIVE: Rheumatoid arthritis (RA) confers substantially elevated cardiovascular disease (CVD) risk. We quantified the association between joint risk factor control and incident CVD among RA patients and examined modification by genetic susceptibility. METHODS: In this prospective UK Biobank cohort, 4,426 RA patients and 17,704 matched non-RA controls were followed for CVD, coronary heart disease (CHD), stroke, and heart failure. A nine-component risk factor control score (0-9) was constructed, incorporating healthy diet, smoking, physical activity, blood pressure, glycated hemoglobin, low-density lipoprotein cholesterol, high-sensitivity C-reactive protein, body mass index, and estimated glomerular filtration rate. Cox models, sensitivity analyses, and restricted mean survival time (RMST) were applied. Least absolute shrinkage and selection operator (LASSO) regression identified CVD-predictive metabolomic features; mediation analysis quantified the metabolomic risk score (MRS) contribution. Polygenic risk score (PRS) joint analyses assessed genetic effect modification. RESULTS: Better control was associated with graded CVD risk reduction (moderate: HR 0.77, 95% CI 0.64-0.93; high: HR 0.46, 95% CI 0.33-0.64 vs. low). High control yielded CVD and CHD risks comparable to non-RA controls and lower stroke risk (HR 0.34, 95% CI 0.13-0.91). RMST showed +3.58 CVD-free years (95% CI 2.49-4.68; P < 0.001). Mediation indicated partial MRS mediation (indirect proportion 34.1%; 20.8% adjusted). No significant interaction with MRS; high control attenuated risk even in high genetic risk. CONCLUSION: Comprehensive control attenuates and may offset RA-excess CVD risk, even with high genetic susceptibility. The effect is partially metabolically mediated yet independent of metabolic status, supporting dual-pathway prevention.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.