Red Meat Tied to High RA Risk; Fruits and Veggies Protective
The risk for developing rheumatoid arthritis (RA) rose with a high intake of red and processed meat vs fruits and vegetables in a case-control study.
METHODOLOGY:
The risk of developing RA based on dietary habits was explored in a Swedish nested case-control study within a prospective study conducted between January 1991 and September 1996 (n = 28,098).
Diet was assessed at baseline using a 7-day menu book, a 168-item questionnaire, and an interview lasting 45-60 minutes, and each RA patient was matched to four control individuals for analysis.
Compliance with the 2015 Swedish Dietary Guidelines for intake of fiber, fruits and vegetables, fish/shellfish, added sugars, and red or processed meat was scored and categorized as low, moderate, or high.
Data from registries and validated electronic medical records identified RA incidence through December 2016; data on rheumatoid factor and anticyclic citrullinated peptide antibody were also retrieved.
TAKEAWAY:
A total of 305 incident cases of RA were identified (76.1% women; 66.9% seropositive), with a mean age of 56.8 years at baseline and an average 12-year interval until diagnosis.
Consuming < 500 g/wk of red and processed meat (adjusted odds ratio [aOR], 0.60; 95% CI, 0.38-0.97) and ≥ 400 g/d of vegetables and fruits (aOR, 0.64; 95% CI, 0.43-0.94) significantly reduced the odds of developing RA.
Lower odds of developing RA were linked to fruits and vegetables (aOR per SD, 0.70; 95% CI, 0.57-0.87) and fiber (aOR per SD, 0.80; 95% CI, 0.64-0.99) vs higher odds with red and processed meat (aOR per SD, 1.31; 95% CI, 1.07-1.59).
Adhering to intake guidelines for all food types was linked to a lower risk for seropositive RA; higher odds were linked to higher consumption of red and processed meat (aOR, 3.43; 95% CI, 1.69-6.96).
IN PRACTICE:
'[The study] findings suggest a dose-response relationship between red/processed meat intake and the risk of seropositive, but not seronegative, RA. This study helps to improve our understanding of the effects of dietary components in RA development, particularly for red and processed meats, but the exact mechanisms behind our findings need further investigation,' the authors concluded.
SOURCE:
This study was led by Rebecka Bäcklund, Lund University, Malmö, Sweden. It was published online on July 10, 2025, in Annals of the Rheumatic Diseases.
LIMITATIONS:
The diet was assessed only at baseline. Data were retrieved from a study that examined the association between diet and cancer, which may have introduced selection bias. Dietary guidelines, especially regarding meat intake, may have changed over time.
DISCLOSURES:
This study received support from the Swedish Rheumatism Association, the Gustav V 80-year fund, the Greta and Johan Kock foundation, and others. The authors declared having no conflicts of interest.
This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.
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Please note that the text below is not a full transcript and has not been copyedited. For more insight and commentary on these stories, subscribe to the This Week in Cardiology podcast , download the Medscape app or subscribe on Apple Podcasts, Spotify, or your preferred podcast provider. This podcast is intended for healthcare professionals only. In This Week's Podcast For the week ending July 25, 2025, John Mandrola, MD, comments on the following topics: The group at the University of Leeds in the UK have published an interesting paper on endurance athletes, cardiac fibrosis, and ventricular arrhythmia. They cheekily named it Ventoux to correspond to a recent Tour de France stage finishing on Mount Ventoux. I've climbed Ventoux. It took me 1 hour 42 minutes. Tadej and Jonas did it this week in 54 minutes—a record by a minute. Imagine liking, no, loving, the notion of climbing a 10% gradient for well more than hour and you will understand the mindset of older endurance athletes. 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Lifelong exercise is protective against diabetes, hypertension, coronary artery disease (CAD), but it may cause small LGEs in a very small proportions of patients. Notice that all these are comments are questions. This study is interesting. Intensely interesting. It's a great effort, but to offer more actionable results, beyond, don't ignore symptoms , which is an easy thing to tell people, we would need larger samples that were crucially more random in sampling. Though they tried, VENTOUX is not all a random sampling of heavy exercisers. Imagine a study wherein you went to an endurance race, and you signed up one out of every five 30-year-olds and followed them serially, as they did in Framingham, with CMR every 5 years for two or three decades. Then we might know more. But such a study is vast and super expensive. For now, I recommend regular exercise as if it was a heart pill or AF pill. You take it daily. Todos los dias. The vast majority of people I see don't exercise enough. What bike racers like to do is not at all for health . It is for fun, or for sanity; whether it is a net harm remains to be seen. But even if it were, I am not sure most of us would stop doing it. Because rodents must run on the wheel. An Australian group of researchers have published a massive systematic review and meta-analysis of daily steps in and health. Lancet Public Health published the study, which was covered in 176 news outlets as of this morning. Most of the news stories say something like the 10,000-step myth has been busted and 7000 is sufficient. The news' stories are wrong. And I will briefly cover this study because it bookends the extreme exercise study quite well. The research team had 57 studies from 35 cohorts included in the systematic review and 31 studies from 24 cohorts included in meta-analyses. They looked at dose response (in steps) and many outcomes including all-cause mortality, cardiovascular disease incidence, dementia, falls, and type 2 diabetes. The comparator or control group was 2000 steps. Compared to that those who reported or documented with counter 7000 steps per day had a: 47% reduction in all-cause death (HR 0.53 [95% CI, 0.46–0.60]; I 2 =36.3; 14 studies) 25% reduction in CV disease incidence (HR 0·75 [0·67–0·85]; I 2 =38·3%; 6 studies) 47% reduction in CV mortality (HR 0·53 [0·37–0·77]; I 2 =78·2%; 3 studies) 37% reduction in cancer mortality (HR 0·63 [0·55–0·72]; I 2 =64·5%; 3 studies) 14% reduction type 2 diabetes (HR 0·86 [0·74–0·99]; I 2 =48·5%; 4 studies) 38% reduction in dementia (HR 0·62 [0·53–0·73]; I 2 =0%; 2 studies) 28% reduction in falls (HR 0·72 [0·65–0·81]; I 2=47·5%; four studies) My issue with this study is that when you go to the main figure, the plots with hazard ratio (HR) on the y-axis and step counts on the x-axis, you see a clear dose response of steps and specific outcomes. 2000 steps is where the HR is 0. If it's less than 2000 steps, the outcomes are actually higher, but as the step count increases the HR drops. The authors pick 7000, I assume because that is where the slope of benefit seems to plateau, but when you look at the curves, the HR keeps dropping with more steps. The authors quantify the added benefit of > 7000 steps per day in Table 8 of the supplement. For all-cause death, there is an added 10% lower HR with 10,000 vs 7000. Same for cancer mortality and depressive symptoms—an added 10% lower relative risk. So I don't think any myths were busted. 7000 is fine. 7000 steps per day is associated with lower bad health outcomes. But for many, including all-cause death, 10,000 is better. The added benefits reached statistical significance. So if a patient asks, the number is still 10,000. Though 7000 is also good. And 5000 is better than 4000, which is better than 3000. After reviewing this study, the thought about European vs American life popped into my head. We have probably 2000 people working at my hospital. Less than 5 of them walk to work; less than 10 of them ride their bike. When I visited the team at Basel, Switzerland last fall, it looked like more than 75% walked or cycled to work. Very few American cities are set up for walking. That's sad. So Americans have to make an effort to be active. I think it's worth it. And I recommend it in the clinic. For my height, 7000 steps is about 3 miles. 10,000 steps is nearly 5 miles. The optimal dose is the longer one. But some is better than none. Everyone Deserves a Shot at the American Dream: Sinus Rhythm Let me say a few words here about rate vs rhythm control, because this may actually be the number one issue in all of electrophysiology. The stimulus for writing such a review piece I think comes from the PRAGUE 25 trial of lifestyle modification vs AF ablation. I have opined on that in my July 11 podcast. In sum, AF ablation led to less AF than risk factor (RF) modification alone, though 35% (or 1 in 3 patients) in the risk factor modification group had sinus rhythm (SR) without ablation. And RF modification led to more weight loss, better glycemic control, and better fitness as measured by VO 2 max. PRAGUE 25 also found no statistical differences in AF burden nor quality of life measures. The sits in the literature as a 'positive' ablation trial, but I actually think, healthwise, it is a 'positive' trial for RF modification. The Medscape article cites a 'hybrid' approach wherein all patients who pursue rhythm control also get risk factor modification, which I totally agree with, and I have to say, is underused, at least in my zip code. The absolute wrong thing to do is ablate the AF and not help the patient lose weight and improve cardiometabolic health. Because if you do this, you have merely reduced a surrogate marker — AF episodes. Health is not improved if obesity, hypertension, diabetes, and poor exercise tolerance remain. You succeed as a proceduralist but fail as a doctor in this scenario. The Medscape article goes on to celebrate the benefits of SR over AF. The next logical step is to laud rhythm control over rate control. And here I have a problem. And I somewhat disagree with friend and colleague Eric Prystowsky, MD. Eric is well known for his criticism of AFFIRM and how that trial set EP back years. But I had the pleasure of speaking in Calgary and met the late Dr. George Wyse, the principal investigator of AFFIRM. AFFIRM is one of those landmark trials that deserves your attention. Published in 2002, a total of 4060 patients with AF were randomized to rate or rhythm control. Mortality was the primary endpoint. Patients in AFFIRM were like those we see every day. 70 years old. Most with hypertension, a third with CAD. At 5 years, 23.8% in the rhythm control arm died vs 21.3% in the rate control arm. The HR was 1.15, or 15% worse for rhythm control. CIs were 0.99-1.34 so the P value for arm was just outside 0.05 but the upper bound or worse case was a 34% higher rate of death in the rhythm control arm. More patients in the rhythm-control group than in the rate-control group were hospitalized, and there were more adverse drug effects in the rhythm-control group as well. AFFIRM was largely interpreted as showing no differences in the two strategies. But, really, there was a strong trend for worse outcomes in the rhythm-control arm. One of the major changes in knowledge that came from AFFIRM is the importance of maintaining oral anticoagulation (AC). In AFFIRM, patients in the rhythm control arm who were maintaining SR could stop their oral AC. This led to a difference in AC use 85% vs 70% rate vs rhythm control. In fact, AFFIRM largely changed the view that patients with AF with either strategy should remain on oral AC. The Sherman et al substudy in JAMA Internal Medicine found that patients who remained on warfarin were 68% less likely to have stroke. A large proportion of ischemic strokes (113 of 157) occurred in patients in whom anticoagulation had been stopped (on the basis of re-established normal sinus rhythm) and who had a subtherapeutic international normalized ratio. Eric's point about AFFIRM is it led to too many patients with AF being told that there was no reason to try to get into SR, and if you don't try, and you leave patients in AF, it becomes impossible to restore SR after a year or so. The other problems (or criticisms) of AFFIRM were that patients had to be able to tolerate rate-control. So highly symptomatic patients were excluded. AFFIRM should never have been applied to these patients. Many of these symptomatic patients were younger, and it is a serious error to just leave a symptomatic younger person with AF forever in AF. Another criticism of AFFIRM was that it only included antiarrhythmic drugs (AAD), and amiodarone was the most common one used. AAD were all that was available at the time. We now know that AF ablation is far more effective at rhythm control than drugs. So there is a like a bridge to SR early on, and many patients can be put into SR with rhythm control. Proponents of aggressive rhythm control also cite the EAST-AF trial, a rhythm vs rate control trial, which strongly favored rhythm control. But EAST-AF suffered from serious performance bias issues wherein the rhythm control arm got oodles more interactions with the health system. Here is my take of the decision: AFFIRM still applies. If you have an older person with minimal to no symptoms from AF, rate control is not only fine but maybe preferred. But if there are a) symptoms, and b) clues that rhythm control is possible (e.g., the LA size is not ginormous, or the patient can cooperate, and maybe the AF is not more than 2 years persistent), I try rhythm control. But I tell patients that while there is benefit from SR (in terms of quality of life) rhythm control is hard. It costs a lot, not only in money, but investment in their time and effort. Patients have to know that RF modification is crucial, they will also have to spend a few days in the hospital (for cardioversions, maybe drug initiation or ablation). Remember, when you are getting cardioversions and AAD and ablations you are not at work or on a bike. You are being a patient. It's fine. It's an investment but patients need to know that rhythm control is unlike a gallbladder operation or an appendectomy. Rhythm control is a process that requires a friendship with a cardiologist. It's not one and done. There are also risks to rhythm control. Drug side effects and ablation complications do occur. My friends, be careful flying close to the sun with rhythm control. One of the biggest mistakes I see in general cardiology is leaping to cardioversion without a plan. CV of AF is fine, but you have to have a plan for what will happen in a week or month when the patient is back in AF. CV doesn't modify the problem of AF. It just resets the heart. In the end: EP is here to help. Get us involved. Especially when there are symptoms. And doubly especially, when there is heart failure. But don't dismiss AFFIRM. It is important trial that shows that rate control is not a terrible strategy in selected patients. GLP-1 RAs Protective Against Stroke, Neurodegeneration? A GLP-1 study purports to show benefit in cerebrovascular health. It actually shows how observational studies can mislead you. The title of the study is, 'Neurodegeneration and Stroke After Semaglutide and Tirzepatide in Patients With Diabetes and Obesity.' 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That's what you expect when healthier patients get one treatment. Immediately better outcomes. If the GLP-1 was better than other drugs, you'd see gradually increasing benefit. Second reason: the mortality benefit is huge. A 30% reduction in death. In the SELECT trial of semaglutide vs placebo in patients with heart disease and obesity, semaglutide only reduced CV mortality by 15%. In the SUSTAIN-6 trial of semaglutide vs placebo, semaglutide had no sig reduction in death or CV death and required a composite endpoint to drive positive results. My overall take, therefore, is that GLP-1 drugs induce weight loss. They do modify disease in patients with obesity and diabetes and patients with obesity and atherosclerotic disease. But whether they reduce important cerebrovascular outcomes like dementia cannot be answered by these confounded observational studies. I am not sure it's worth doing these studies because the only value is to show readers the signs of bias in non-random, retrospective comparison studies.
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