DOI: 10.1161/jaha.125.045422 ISSN: 2047-9980

Association of the Endothelial Activation and Stress Index With Cardiovascular Disease Prevalence and Mortality in Individuals With Rheumatoid Arthritis: First Population‐Based Evidence From the National Health and Nutrition Examination Survey

Junwei Chen, Cong Zhang, Jianbang Fang, Chunyang Lou, Pengfei Shi
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Background

Patients with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD); however, effective risk stratification tools remain limited. The Endothelial Activation and Stress Index (EASIX) is a composite biomarker reflecting endothelial injury and cellular stress, but its association with CVD in populations with RA remains unexplored. This study aimed to investigate the association between EASIX and both CVD prevalence and CVD mortality in individuals with RA using a nationally representative sample.

Methods

Data were obtained from the National Health and Nutrition Examination Survey 2001 to 2018. Adults with RA and complete information on EASIX components and cardiovascular outcomes were included. EASIX was calculated as (lactate dehydrogenase×creatinine)/platelet count. Logistic regression and Cox proportional hazards models were used to evaluate the associations between EASIX, CVD prevalence, and CVD mortality, adjusting for potential confounders.

Results

A total of 1857 participants with RA were included. Higher EASIX scores were significantly associated with increased odds of CVD prevalence and an elevated risk of CVD mortality. Notably, a nonlinear association was observed between EASIX and CVD mortality, indicating a threshold effect. These associations remained robust after controlling for systemic inflammation and other potential confounders. The robustness of our results was further supported by subgroup and sensitivity analyses.

Conclusions

This is the first study to demonstrate a significant association between EASIX and both CVD prevalence and mortality in individuals with RA. The findings highlight EASIX as a promising, easily accessible biomarker for cardiovascular risk stratification in this high‐risk population.

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