LAP-defined hepatic steatosis and cardiometabolic risk in rheumatoid arthritis: a post-hoc analysis of the FRANCIS randomized trial
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease associated with metabolic dysfunction-associated steatotic liver disease (MASLD), which may contribute to cardiovascular (CV) risk. This study aimed to examine the association between hepatic steatosis, measured by a non-invasive test, and CV risk markers in RA patients. This post-hoc analysis used cross-sectional and longitudinal data from the Franciscus Rheumatoid Arthritis and Cardiovascular Intervention Study (FRANCIS), an open-label randomized controlled trial of intensive CV risk management in patients with rheumatoid arthritis without cardiovascular disease (CVD) or type 2 diabetes. Hepatic steatosis was assessed using the Lipid Accumulation Product (LAP) with sex-specific thresholds for rule-in and rule-out of severe steatosis. Associations between hepatic steatosis and carotid intima-media thickness (cIMT) were assessed using linear regression analysis. Crude associations were first evaluated in unadjusted models, followed by multivariable models adjusting for age, sex, BMI, and systolic blood pressure. Longitudinal changes in cIMT over 3 years were analyzed according to LAP-defined steatosis and treatment strategy. Among 236 RA patients (66% female; mean age 54 ± 10 years), those with LAP-defined steatosis had a more adverse cardiometabolic profile, including higher blood pressure, fasting glucose, and a more atherogenic lipid profile (all p < 0.05). Mean cIMT tended to be higher in the steatosis group (0.61…
How strong is the evidence?
Evidence Hub reads this as a secondary / pooled analysis, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 236 participants or records.
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