Osteoarthritis and the risk of cardiovascular disease: a meta-analysis of observational studies

Previous observational studies have suggested a potential relationship between osteoarthritis (OA) and the risk of cardiovascular disease (CVD), with conflicting results. We aimed to provide a systematic and quantitative summary of the association between OA and the risk of CVD. We searched Medline...

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Published in:	Scientific reports Vol. 6; no. 1; p. 39672
Main Authors:	Wang, Haoran, Bai, Jing, He, Bing, Hu, Xinrong, Liu, Dongliang
Format:	Journal Article
Language:	English
Published:	London Nature Publishing Group UK 22.12.2016 Nature Publishing Group
Subjects:	692/308/174 692/4023/1670/407 692/499 692/699/75 Arthritis Cardiovascular disease Cardiovascular diseases Cardiovascular Diseases - epidemiology Female Health risk assessment Health risks Humanities and Social Sciences Humans Male Meta-analysis multidisciplinary Observational studies Observational Studies as Topic Osteoarthritis Osteoarthritis - epidemiology Prospective Studies Regression Analysis Research Design Retrospective Studies Risk Factors Science Sensitivity analysis Sensitivity and Specificity Stroke - epidemiology Studies Treatment Outcome
ISSN:	2045-2322, 2045-2322
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Abstract	Previous observational studies have suggested a potential relationship between osteoarthritis (OA) and the risk of cardiovascular disease (CVD), with conflicting results. We aimed to provide a systematic and quantitative summary of the association between OA and the risk of CVD. We searched Medline and EMBASE to retrieve prospective and retrospective studies that reported risk estimates of the association between OA status and CVD risk. Pooled estimates were calculated by a random effects model. The search yielded 15 articles including a total of 358,944 participants, including 80,911 OA patients and 29,213 CVD patients. Overall, the risk of CVD was significantly increased by 24% (RR: 1.24, 95% CI: 1.12 to 1.37, P < 0.001) in patients with OA compared with the general population, with no significant publication bias. Furthermore, sensitivity analysis indicated that our results were robust and were not influenced by any one study. In conclusion, this meta-analysis provides strong evidence that OA is a significant risk factor for CVD.
AbstractList	Previous observational studies have suggested a potential relationship between osteoarthritis (OA) and the risk of cardiovascular disease (CVD), with conflicting results. We aimed to provide a systematic and quantitative summary of the association between OA and the risk of CVD. We searched Medline and EMBASE to retrieve prospective and retrospective studies that reported risk estimates of the association between OA status and CVD risk. Pooled estimates were calculated by a random effects model. The search yielded 15 articles including a total of 358,944 participants, including 80,911 OA patients and 29,213 CVD patients. Overall, the risk of CVD was significantly increased by 24% (RR: 1.24, 95% CI: 1.12 to 1.37, P < 0.001) in patients with OA compared with the general population, with no significant publication bias. Furthermore, sensitivity analysis indicated that our results were robust and were not influenced by any one study. In conclusion, this meta-analysis provides strong evidence that OA is a significant risk factor for CVD. Previous observational studies have suggested a potential relationship between osteoarthritis (OA) and the risk of cardiovascular disease (CVD), with conflicting results. We aimed to provide a systematic and quantitative summary of the association between OA and the risk of CVD. We searched Medline and EMBASE to retrieve prospective and retrospective studies that reported risk estimates of the association between OA status and CVD risk. Pooled estimates were calculated by a random effects model. The search yielded 15 articles including a total of 358,944 participants, including 80,911 OA patients and 29,213 CVD patients. Overall, the risk of CVD was significantly increased by 24% (RR: 1.24, 95% CI: 1.12 to 1.37, P < 0.001) in patients with OA compared with the general population, with no significant publication bias. Furthermore, sensitivity analysis indicated that our results were robust and were not influenced by any one study. In conclusion, this meta-analysis provides strong evidence that OA is a significant risk factor for CVD.Previous observational studies have suggested a potential relationship between osteoarthritis (OA) and the risk of cardiovascular disease (CVD), with conflicting results. We aimed to provide a systematic and quantitative summary of the association between OA and the risk of CVD. We searched Medline and EMBASE to retrieve prospective and retrospective studies that reported risk estimates of the association between OA status and CVD risk. Pooled estimates were calculated by a random effects model. The search yielded 15 articles including a total of 358,944 participants, including 80,911 OA patients and 29,213 CVD patients. Overall, the risk of CVD was significantly increased by 24% (RR: 1.24, 95% CI: 1.12 to 1.37, P < 0.001) in patients with OA compared with the general population, with no significant publication bias. Furthermore, sensitivity analysis indicated that our results were robust and were not influenced by any one study. In conclusion, this meta-analysis provides strong evidence that OA is a significant risk factor for CVD.
ArticleNumber	39672
Author	He, Bing Wang, Haoran Hu, Xinrong Liu, Dongliang Bai, Jing
Author_xml	– sequence: 1 givenname: Haoran surname: Wang fullname: Wang, Haoran organization: Department of Cardiology, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College – sequence: 2 givenname: Jing surname: Bai fullname: Bai, Jing organization: Department of Endocrinology and Diabetes, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College – sequence: 3 givenname: Bing surname: He fullname: He, Bing organization: Department of Joint Surgery, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College – sequence: 4 givenname: Xinrong surname: Hu fullname: Hu, Xinrong organization: Department of Cardiology, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College – sequence: 5 givenname: Dongliang surname: Liu fullname: Liu, Dongliang organization: Department of Cardiology, Luohe Central Hospital, The First Affiliated Hospital of Luohe Medical College
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Clinical rheumatology20142851510.1016/j.berh.2014.01.004 NielenMMCardiovascular disease prevalence in patients with inflammatory arthritis, diabetes mellitus and osteoarthritis: a cross-sectional study in primary careBMC musculoskeletal disorders20121315010.1186/1471-2474-13-150229060833493278 ConaghanPGVanharantaHDieppePAIs progressive osteoarthritis an atheromatous vascular disease?Annals of the rheumatic diseases200564153915411:STN:280:DC%2BD2MrkvFektw%3D%3D10.1136/ard.2005.039263161075121755271 KishimotoMArthritis as a risk factor for incident coronary heart disease in elderly Japanese-American males - the Honolulu Heart ProgramBulletin of the NYU hospital for joint diseases20096723023519583559 HoevenTADisability and not osteoarthritis predicts cardiovascular disease: a prospective population-based cohort studyAnnals of the rheumatic diseases2015747527561:STN:280:DC%2BC2czhs1KrsA%3D%3D10.1136/annrheumdis-2013-20438824385204 YusufEAssociation between weight or body mass index and hand osteoarthritis: a systematic reviewAnnals of the rheumatic diseases20106976176510.1136/ard.2008.10693019487215 HallAJStubbsBMamasMAMyintPKSmithTOAssociation between osteoarthritis and cardiovascular disease: Systematic review and meta-analysisEuropean journal of preventive cardiology20162393894610.1177/204748731561066326464295 KadamUTJordanKCroftPRClinical comorbidity in patients with osteoarthritis: a case-control study of general practice consulters in England and WalesAnnals of the rheumatic diseases2004634084141:STN:280:DC%2BD2c7islertQ%3D%3D10.1136/ard.2003.007526150203351754944 NueschEAll cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort studyBmj2011342d116510.1136/bmj.d1165213858073050438 HartDJDoyleDVSpectorTDAssociation between metabolic factors and knee osteoarthritis in women: the Chingford StudyThe Journal of rheumatology199522111811231:STN:280:DyaK2MvgsVGmsg%3D%3D7674240 CherasPAFreemontAJSikorskiJMIntraosseous thrombosis in ischemic necrosis of bone and osteoarthritisOsteoarthritis and cartilage/OARS, Osteoarthritis Research Society199312192321:STN:280:DC%2BD2cvotFCgsA%3D%3D10.1016/S1063-4584(05)80328-0 TrelleSCardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysisBmj2011342c708610.1136/bmj.c7086212243243019238 HaugenIKHand osteoarthritis in relation to mortality and incidence of cardiovascular disease: data from the Framingham heart studyAnnals of the rheumatic diseases201574748110.1136/annrheumdis-2013-20378924047870 EggerMDavey SmithGSchneiderMMinderCBias in meta-analysis detected by a simple, graphical testBmj19973156296341:STN:280:DyaK2svls1KjtA%3D%3D10.1136/bmj.315.7109.62993105632127453 RahmanMMKopecJAAnisAHCibereJGoldsmithCHRisk of cardiovascular disease in patients with osteoarthritis: a prospective longitudinal studyArthritis care & research2013651951195810.1002/acr.22092 LouatiKVidalCBerenbaumFSellamJAssociation between diabetes mellitus and osteoarthritis: systematic literature review and meta-analysisRMD open20151e00007710.1136/rmdopen-2015-000077265351374613158 HaaraMMOsteoarthritis of finger joints in Finns aged 30 or over: prevalence, determinants, and association with mortalityAnnals of the rheumatic diseases2003621511581:STN:280:DC%2BD3s%2FktlCqtw%3D%3D10.1136/ard.62.2.151125253851754437 PuenpatomRAVictorTWIncreased prevalence of metabolic syndrome in individuals with osteoarthritis: an analysis of NHANES III dataPostgraduate medicine200912192010.3810/pgm.2009.11.207319940413 GreenGAUnderstanding NSAIDs: from aspirin to COX-2Clinical cornerstone2001350601:STN:280:DC%2BD38%2Fit12gsg%3D%3D10.1016/S1098-3597(01)90069-911464731 Rahman, M. M., Kopec, J. A., Cibere, J., Goldsmith, C. H. & Anis, A. H. The relationship between osteoarthritis and cardiovascular disease in a population health survey: a cross-sectional study. BMJ open 3, doi: 10.1136/bmjopen-2013-002624 (2013). OngKLWuBJCheungBMBarterPJRyeKAArthritis: its prevalence, risk factors, and association with cardiovascular diseases in the United States, 1999 to 2008Annals of epidemiology201323808610.1016/j.annepidem.2012.11.00823218811 ZhangJYuKFWhat’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomesJama1998280169016911:STN:280:DyaK1M%2FkvVynsw%3D%3D10.1001/jama.280.19.16909832001 JonssonHHand osteoarthritis in older women is associated with carotid and coronary atherosclerosis: the AGES Reykjavik studyAnnals of the rheumatic diseases200968169617001:STN:280:DC%2BD1MnotVKmtA%3D%3D10.1136/ard.2008.09628919033292 IgnarroLJBalestrieriMLNapoliCNutrition, physical activity, and cardiovascular disease: an updateCardiovascular research2007733263401:CAS:528:DC%2BD2sXpvVyg10.1016/j.cardiores.2006.06.03016945357 Mortality, G. B. D. & Causes of Death, C. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 385, 117–171, doi: 10.1016/S0140-6736(14)61682-2 (2015). S Trelle (BFsrep39672_CR24) 2011; 342 D Moher (BFsrep39672_CR29) 2009; 6 IK Haugen (BFsrep39672_CR5) 2015; 74 VL Johnson (BFsrep39672_CR2) 2014; 28 E Nuesch (BFsrep39672_CR13) 2011; 342 JP Higgins (BFsrep39672_CR31) 2002; 21 MM Haara (BFsrep39672_CR8) 2003; 62 MM Rahman (BFsrep39672_CR15) 2013; 65 BFsrep39672_CR11 BFsrep39672_CR16 AJ Hall (BFsrep39672_CR28) 2016; 23 RA Puenpatom (BFsrep39672_CR19) 2009; 121 PG Bullough (BFsrep39672_CR27) 1990; 49 M Tsuboi (BFsrep39672_CR17) 2011; 29 TA Hoeven (BFsrep39672_CR6) 2015; 74 GA Green (BFsrep39672_CR3) 2001; 3 KL Ong (BFsrep39672_CR14) 2013; 23 DJ Hart (BFsrep39672_CR22) 1995; 22 N Veronese (BFsrep39672_CR18) 2016; 68 BFsrep39672_CR1 KE Barbour (BFsrep39672_CR7) 2015; 67 MM Nielen (BFsrep39672_CR12) 2012; 13 M Kishimoto (BFsrep39672_CR10) 2009; 67 J Zhang (BFsrep39672_CR30) 1998; 280 H Jonsson (BFsrep39672_CR4) 2009; 68 K Louati (BFsrep39672_CR21) 2015; 1 LJ Ignarro (BFsrep39672_CR25) 2007; 73 UT Kadam (BFsrep39672_CR9) 2004; 63 PA Cheras (BFsrep39672_CR26) 1993; 1 PG Conaghan (BFsrep39672_CR20) 2005; 64 E Yusuf (BFsrep39672_CR23) 2010; 69 M Egger (BFsrep39672_CR32) 1997; 315
References_xml	– reference: TsuboiMDo musculoskeletal degenerative diseases affect mortality and cause of death after 10 years in Japan?Journal of bone and mineral metabolism20112921722310.1007/s00774-010-0214-z20711854 – reference: HoevenTADisability and not osteoarthritis predicts cardiovascular disease: a prospective population-based cohort studyAnnals of the rheumatic diseases2015747527561:STN:280:DC%2BC2czhs1KrsA%3D%3D10.1136/annrheumdis-2013-20438824385204 – reference: Rahman, M. M., Kopec, J. A., Cibere, J., Goldsmith, C. H. & Anis, A. H. The relationship between osteoarthritis and cardiovascular disease in a population health survey: a cross-sectional study. BMJ open 3, doi: 10.1136/bmjopen-2013-002624 (2013). – reference: VeroneseNAssociation of Osteoarthritis With Increased Risk of Cardiovascular Diseases in the Elderly: Findings From the Progetto Veneto Anziano Study CohortArthritis & rheumatology201668113611441:CAS:528:DC%2BC28XmvVertro%3D10.1002/art.39564 – reference: ConaghanPGVanharantaHDieppePAIs progressive osteoarthritis an atheromatous vascular disease?Annals of the rheumatic diseases200564153915411:STN:280:DC%2BD2MrkvFektw%3D%3D10.1136/ard.2005.039263161075121755271 – reference: BulloughPGDiCarloEFSubchondral avascular necrosis: a common cause of arthritisAnnals of the rheumatic diseases1990494124201:STN:280:DyaK3czktlCnsw%3D%3D10.1136/ard.49.6.41222003571004114 – reference: ZhangJYuKFWhat’s the relative risk? A method of correcting the odds ratio in cohort studies of common outcomesJama1998280169016911:STN:280:DyaK1M%2FkvVynsw%3D%3D10.1001/jama.280.19.16909832001 – reference: PuenpatomRAVictorTWIncreased prevalence of metabolic syndrome in individuals with osteoarthritis: an analysis of NHANES III dataPostgraduate medicine200912192010.3810/pgm.2009.11.207319940413 – reference: YusufEAssociation between weight or body mass index and hand osteoarthritis: a systematic reviewAnnals of the rheumatic diseases20106976176510.1136/ard.2008.10693019487215 – reference: JohnsonVLHunterDJThe epidemiology of osteoarthritisBest practice & research. Clinical rheumatology20142851510.1016/j.berh.2014.01.004 – reference: HartDJDoyleDVSpectorTDAssociation between metabolic factors and knee osteoarthritis in women: the Chingford StudyThe Journal of rheumatology199522111811231:STN:280:DyaK2MvgsVGmsg%3D%3D7674240 – reference: IgnarroLJBalestrieriMLNapoliCNutrition, physical activity, and cardiovascular disease: an updateCardiovascular research2007733263401:CAS:528:DC%2BD2sXpvVyg10.1016/j.cardiores.2006.06.03016945357 – reference: Kluzek, S. et al. Painful knee but not hand osteoarthritis is an independent predictor of mortality over 23 years follow-up of a population-based cohort of middle-aged women. Annals of the rheumatic diseases, doi: 10.1136/annrheumdis-2015-208056 (2015). – reference: HaugenIKHand osteoarthritis in relation to mortality and incidence of cardiovascular disease: data from the Framingham heart studyAnnals of the rheumatic diseases201574748110.1136/annrheumdis-2013-20378924047870 – reference: OngKLWuBJCheungBMBarterPJRyeKAArthritis: its prevalence, risk factors, and association with cardiovascular diseases in the United States, 1999 to 2008Annals of epidemiology201323808610.1016/j.annepidem.2012.11.00823218811 – reference: TrelleSCardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysisBmj2011342c708610.1136/bmj.c7086212243243019238 – reference: Mortality, G. B. D. & Causes of Death, C. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 385, 117–171, doi: 10.1016/S0140-6736(14)61682-2 (2015). – reference: GreenGAUnderstanding NSAIDs: from aspirin to COX-2Clinical cornerstone2001350601:STN:280:DC%2BD38%2Fit12gsg%3D%3D10.1016/S1098-3597(01)90069-911464731 – reference: HaaraMMOsteoarthritis of finger joints in Finns aged 30 or over: prevalence, determinants, and association with mortalityAnnals of the rheumatic diseases2003621511581:STN:280:DC%2BD3s%2FktlCqtw%3D%3D10.1136/ard.62.2.151125253851754437 – reference: NielenMMCardiovascular disease prevalence in patients with inflammatory arthritis, diabetes mellitus and osteoarthritis: a cross-sectional study in primary careBMC musculoskeletal disorders20121315010.1186/1471-2474-13-150229060833493278 – reference: RahmanMMKopecJAAnisAHCibereJGoldsmithCHRisk of cardiovascular disease in patients with osteoarthritis: a prospective longitudinal studyArthritis care & research2013651951195810.1002/acr.22092 – reference: CherasPAFreemontAJSikorskiJMIntraosseous thrombosis in ischemic necrosis of bone and osteoarthritisOsteoarthritis and cartilage/OARS, Osteoarthritis Research Society199312192321:STN:280:DC%2BD2cvotFCgsA%3D%3D10.1016/S1063-4584(05)80328-0 – reference: EggerMDavey SmithGSchneiderMMinderCBias in meta-analysis detected by a simple, graphical testBmj19973156296341:STN:280:DyaK2svls1KjtA%3D%3D10.1136/bmj.315.7109.62993105632127453 – reference: JonssonHHand osteoarthritis in older women is associated with carotid and coronary atherosclerosis: the AGES Reykjavik studyAnnals of the rheumatic diseases200968169617001:STN:280:DC%2BD1MnotVKmtA%3D%3D10.1136/ard.2008.09628919033292 – reference: BarbourKEHip Osteoarthritis and the Risk of All-Cause and Disease-Specific Mortality in Older Women: A Population-Based Cohort StudyArthritis & rheumatology2015671798180510.1002/art.39113 – reference: KishimotoMArthritis as a risk factor for incident coronary heart disease in elderly Japanese-American males - the Honolulu Heart ProgramBulletin of the NYU hospital for joint diseases20096723023519583559 – reference: KadamUTJordanKCroftPRClinical comorbidity in patients with osteoarthritis: a case-control study of general practice consulters in England and WalesAnnals of the rheumatic diseases2004634084141:STN:280:DC%2BD2c7islertQ%3D%3D10.1136/ard.2003.007526150203351754944 – reference: MoherDLiberatiATetzlaffJAltmanDGGroupPPreferred reporting items for systematic reviews and meta-analyses: the PRISMA statementPLoS medicine20096e100009710.1371/journal.pmed.1000097196210722707599 – reference: NueschEAll cause and disease specific mortality in patients with knee or hip osteoarthritis: population based cohort studyBmj2011342d116510.1136/bmj.d1165213858073050438 – reference: HallAJStubbsBMamasMAMyintPKSmithTOAssociation between osteoarthritis and cardiovascular disease: Systematic review and meta-analysisEuropean journal of preventive cardiology20162393894610.1177/204748731561066326464295 – reference: HigginsJPThompsonSGQuantifying heterogeneity in a meta-analysisStatistics in medicine2002211539155810.1002/sim.118612111919 – reference: LouatiKVidalCBerenbaumFSellamJAssociation between diabetes mellitus and osteoarthritis: systematic literature review and meta-analysisRMD open20151e00007710.1136/rmdopen-2015-000077265351374613158 – volume: 3 start-page: 50 year: 2001 ident: BFsrep39672_CR3 publication-title: Clinical cornerstone doi: 10.1016/S1098-3597(01)90069-9 – volume: 64 start-page: 1539 year: 2005 ident: BFsrep39672_CR20 publication-title: Annals of the rheumatic diseases doi: 10.1136/ard.2005.039263 – volume: 342 start-page: c7086 year: 2011 ident: BFsrep39672_CR24 publication-title: Bmj doi: 10.1136/bmj.c7086 – volume: 29 start-page: 217 year: 2011 ident: BFsrep39672_CR17 publication-title: Journal of bone and mineral metabolism doi: 10.1007/s00774-010-0214-z – volume: 74 start-page: 752 year: 2015 ident: BFsrep39672_CR6 publication-title: Annals of the rheumatic diseases doi: 10.1136/annrheumdis-2013-204388 – ident: BFsrep39672_CR11 doi: 10.1136/annrheumdis-2015-208056 – volume: 73 start-page: 326 year: 2007 ident: BFsrep39672_CR25 publication-title: Cardiovascular research doi: 10.1016/j.cardiores.2006.06.030 – volume: 74 start-page: 74 year: 2015 ident: BFsrep39672_CR5 publication-title: Annals of the rheumatic diseases doi: 10.1136/annrheumdis-2013-203789 – volume: 1 start-page: 219 year: 1993 ident: BFsrep39672_CR26 publication-title: Osteoarthritis and cartilage/OARS, Osteoarthritis Research Society doi: 10.1016/S1063-4584(05)80328-0 – volume: 62 start-page: 151 year: 2003 ident: BFsrep39672_CR8 publication-title: Annals of the rheumatic diseases doi: 10.1136/ard.62.2.151 – volume: 68 start-page: 1136 year: 2016 ident: BFsrep39672_CR18 publication-title: Arthritis & rheumatology doi: 10.1002/art.39564 – volume: 65 start-page: 1951 year: 2013 ident: BFsrep39672_CR15 publication-title: Arthritis care & research doi: 10.1002/acr.22092 – volume: 6 start-page: e1000097 year: 2009 ident: BFsrep39672_CR29 publication-title: PLoS medicine doi: 10.1371/journal.pmed.1000097 – volume: 49 start-page: 412 year: 1990 ident: BFsrep39672_CR27 publication-title: Annals of the rheumatic diseases doi: 10.1136/ard.49.6.412 – volume: 28 start-page: 5 year: 2014 ident: BFsrep39672_CR2 publication-title: Best practice & research. 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SubjectTerms	692/308/174 692/4023/1670/407 692/499 692/699/75 Arthritis Cardiovascular disease Cardiovascular diseases Cardiovascular Diseases - epidemiology Female Health risk assessment Health risks Humanities and Social Sciences Humans Male Meta-analysis multidisciplinary Observational studies Observational Studies as Topic Osteoarthritis Osteoarthritis - epidemiology Prospective Studies Regression Analysis Research Design Retrospective Studies Risk Factors Science Sensitivity analysis Sensitivity and Specificity Stroke - epidemiology Studies Treatment Outcome
Title	Osteoarthritis and the risk of cardiovascular disease: a meta-analysis of observational studies
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