Prevalence and risk factors of cardiovascular metabolic comorbidities in patients with rheumatoid arthritis: a real-world cross-sectional study

Objective Rheumatoid arthritis (RA) patients have a significantly increased risk of cardiovascular disease (CVD). The aim of this study is to explore the influencing factors associated with the aggregation of multiple cardiovascular metabolic risk factors in RA patients. Method This study included 1013 RA patients. According to the preset number of cardiovascular risk factors (obesity, dyslipidemia, hypertension and diabetes), patients were divided into three groups: 0, 1 and ≥ 2 risk factor groups. We collected and compared demographic, clinical characteristics, and disease activity indicators of each group. Use multivariate logistic regression analysis to identify factors independently associated with having ≥ 2 risk factors, and conduct sensitivity and subgroup analysis to validate the robustness of the results. Result Among the total population, 368 patients (36.3%) had ≥ 2 cardiovascular risk factors. Multivariate analysis showed that increasing age (OR = 1.023, 95% CI: 1.007–1.039), elevated systolic blood pressure (SBP) (OR = 1.054, 95% CI: 1.042–1.067), elevated body mass index (BMI) (OR = 1.257, 95% CI: 1.194–1.324), elevated triglycerides (TG) (OR = 2.174, 95% CI: 1.620–2.919), elevated fasting blood glucose (FPG) (OR = 1.524, 95% CI: 1.279–1.816), and elevated levels of high-sensitivity C-reactive protein (CRP) (OR = 1.006, 95% CI: 1.002–1.010) are independent risk factors for the aggregation of multiple risk factors. The increase in high-density lipoprotein cholesterol (HDL-C) (OR = 0.170, 95% CI: 0.084–0.344) is a protective factor. The use of statins is significantly associated with high risk burden (OR = 3.404), which may be a confounding effect of their indications for use. Sensitivity analysis confirmed the consistent association of these factors across different risk stratification. Subgroup analysis revealed significant gender differences: CRP was an independent predictor for male patients, while FPG and statin use had a greater impact on female patients. Conclusion In RA patients, traditional cardiovascular risk factors (age, blood pressure, blood lipids, blood glucose) and systemic inflammation (CRP) jointly promote a high burden of cardiovascular metabolic comorbidities. Clinical management should adopt a comprehensive strategy that actively screens and intervenes in traditional metabolic risk factors while controlling inflammation, and should consider gender specific strategies.