Work

Triglyceride-glucose index combined with DAS28-ESR predicts cardiovascular disease risk in patients with rheumatoid arthritis: a national multicenter cohort study

Year: 2026

Type: article

Abstract: Background Patients with rheumatoid arthritis (RA) face a significantly increased risk of cardiovascular disease (CVD). This study aimed to evaluate the combined predictive value of systemic autoimmune inflammatory burden and chronic glucose-lipid metabolic disorder on long-term CVD outcomes in RA patients and to elucidate the dynamic trajectories of these factors during follow-up and their prognostic implications. Methods This prospective longitudinal cohort study included 4,902 RA patients without baseline CVD. Baseline and follow-up exposure matrices (G1-G4 groups) were constructed using the triglyceride-glucose (TyG) index and DAS28-ESR score. Multistage nested Cox proportional hazard regression models were employed to assess the independent prognostic value of combined exposure and dynamic trajectories on incident CVD. Restricted cubic splines (RCS) quantified nonlinear dose-response relationships, and the Delta method analysis evaluated additive interaction synergistic effects. Results During a median 6-year follow-up, 355 incident CVD events occurred (7.24%). In the fully adjusted multifactorial model (Model 3), the baseline dual-high immune-metabolic exposure group (G4) showed significantly elevated incident CVD risk compared to the dual-low control group (G1) (HR 9.46, 95% CI 3.90-22.96, P < 0.001). Additive interaction analysis confirmed a significant synergistic effect (relative excess risk due to interaction [RERI] of 3.55; 95% CI, 0.46–6.64), with 38% of CVD events in the dual-high group attributable to this additive interaction. RCS analysis demonstrated significant nonlinear associations between both continuous variables and CVD risk ( P < 0.05). Dynamic trajectory analysis revealed that sustained dual-high exposure (G4→G4) during follow-up was associated with a progressive increase in CVD risk (HR 6.95, 95% CI 2.06–23.41, P < 0.001), whereas the inflammation-controlled but metabolic-high-risk group (G2→G3) demonstrated residual cardiovascular risk (HR 1.24, 95% CI 0.28–5.48). Conclusions Baseline dual-high immune-metabolic status and adverse longitudinal trajectories are independently associated with incident CVD events in RA patients, with significant synergistic amplification effects. These findings underscore the clinical urgency to transition from a single anti-inflammatory paradigm toward combined dual-track immune-metabolic targeted intervention strategies to optimize the prevention and control of cardiovascular comorbidity in RA.

Source: Scientific Reports

DOI: 10.1038/s41598-026-75509-w