Association between biological aging and clinical mortality among patients with rheumatoid arthritis

Biological aging constitutes a well-recognized risk factor for age-associated diseases; nevertheless, its specific impact on individuals with rheumatoid arthritis (RA) has not been comprehensively elucidated. This study aimed to investigate the relationships between biological aging and clinical outcomes, including reductions in life expectancy, among patients with RA.

We analyzed data from 45,119 participants of the National Health and Nutrition Examination Survey (NHANES). Biological aging was quantified using the recently validated Gompertz Law-Based Biological Age (GOLD BioAge) metric. Additionally, accelerated biological aging was determined by calculating the discrepancy between biological age and chronological age. A simplified version of the GOLD BioAge, referred to as Light BioAge, was also examined. Logistic regression models were applied to assess the cross-sectional association between biological aging and RA. Longitudinal relationships between biological aging and the incidence of cardiovascular disease (CVD), heart disease, and malignancies were evaluated using Cox proportional hazards models. Furthermore, threshold effect analyses were conducted to explore potential non-linear associations.

Patients with RA exhibited pronounced accelerated biological aging, which was identified as a significant risk factor for RA based on both GOLD BioAge and Light BioAge measures. GOLD BioAge demonstrated a significant association with increased all-cause mortality and cancer risk among RA patients, with threshold effect analysis revealing a non-linear relationship (p < 0.05). Moreover, RA patients exhibiting substantial acceleration in GOLD BioAge showed a proportionally increased risk of mortality attributable to CVD, heart disease, and malignancies, characterized by a linear association (p > 0.05).

Biological aging is closely associated with a heightened risk of all-cause mortality and decreased life expectancy in individuals diagnosed with RA. Therefore, therapeutic interventions targeting the fundamental biological mechanisms of aging may represent a promising avenue for mitigating morbidity in this vulnerable population. Key Points • Accelerated biological aging was prominently observed in patients with RA and identified as a substantial risk factor for the disease, as assessed by both the GOLD BioAge and Light BioAge metrics. • The GOLD BioAge measure exhibited a significant association with increased all-cause mortality and cancer risk in RA patients, characterized by a non-linear relationship. • Furthermore, RA patients exhibiting pronounced acceleration in GOLD BioAge demonstrated a proportionally elevated risk of mortality attributable to cardiovascular disease, heart disease, and malignancies, following a linear association.