Cardiovascular Risk Higher in Patients with Low BMI, Study Suggests

A recent retrospective cohort study has indicated that obesity exhibits a significant impact on cardiovascular disease (CVD) risk in patients with concurrent type 2 diabetes mellitus (T2DM) and psoriatic arthritis (PsA), particularly in those with lower BMI measurements.

Presented at the 9th Annual Heart in Diabetes Conference in Philadelphia, PA, these data highlight the need to avoid the “obesity paradox” to reach all susceptible patients, regardless of the absence of standard warning signs.1

PsA, a chronic inflammatory disease occurring in patients with arthritis, is well known to contribute to increased CVD risk. Affecting both men and women between the ages of 40-50 years, PsA is also associated with comorbidities such as osteoporosis, uveitis, and subclinical bowel inflammation. This inherent heterogeneity makes diagnosis difficult.2

CVD is also the leading cause of death in patients with T2DM; the major associated diseases include ischemic heart disease, heart failure, stroke, coronary artery disease, and peripheral artery disease. These complications result in death for ≥50% of patients with T2DM. The insulin resistance that characterizes T2DM is also a critical cause for CVD.3

Despite these independent associations, the combined impact of PsA and T2DM on cardiovascular disease risk remains largely understudied. To that end, Godbless Ajenaghughrure, MD, an international resident at TriHealth Good Samaritan Hospital, and colleagues analyzed data from the TriNetX research network to compare cardiovascular outcomes between patients with PsA and T2DM stratified by BMI.1

Investigators separated patients into two groups, matched by propensity score across demographic and clinical characteristics. Cohort 1 included 9762 patients without obesity (BMI <30 kg/m2), and Cohort 2 included 9762 patients with obesity (BMI 30-60 kg/m2). Outcomes were assessed over a 5-year follow-up period.1

Ajenaghughrure and colleagues found that all-cause mortality was substantially higher in patients without obesity than with obesity (9.1% versus 5.9%, risk difference 3.2%, 95% CI, 2.5-4%; P <.001). Patients without obesity also demonstrated a lower survival probability at the end of the 5-year follow-up (84.7% versus 90.2%, hazard ratio [HR], 1.65; 95% CI, 1.49-1.83; P <.001). Additionally, cardiac arrest (2.5% vs 1.1%), cerebral infarction (6.6% vs 4.3%), heart failure (17.1% vs 9.6%), and pulmonary embolism (3.3% vs 2%) were all significantly higher in patients in Cohort 1 than those in Cohort 2 (all P <.001).1

Investigators noted these data as further evidence for the “obesity paradox,” a situation in which patients who do not present with obesity have a higher risk of obesity-related health disorders and diseases than those who present with obesity. This “paradox” is a critical issue in public knowledge of obesity and its related risks.1

“This apparent ‘obesity paradox’ warrants further investigation into underlying mechanisms, including potential disease severity, inflammatory burden, and metabolic differences between these populations,” Ajenaghughrure and colleagues wrote.1

References

1. Ajenaghughrure, G, et al. Impact of obesity on cardiovascular outcomes in patients with psoriatic arthritis and type 2 diabetes mellitus. Abstract presented at the 9th Annual Heart in Diabetes Conference in Philadelphia, PA, June 6-8, 2025.

2. Ocampo D V, Gladman D. Psoriatic arthritis. F1000Res. 2019;8:F1000 Faculty Rev-1665. Published 2019 Sep 20. doi:10.12688/f1000research.19144.1

3. Ma CX, Ma XN, Guan CH, Li YD, Mauricio D, Fu SB. Cardiovascular disease in type 2 diabetes mellitus: progress toward personalized management. Cardiovasc Diabetol. 2022;21(1):74. Published 2022 May 14. doi:10.1186/s12933-022-01516-6