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Duration of knee, hip OA may increase cardiovascular mortality

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LIVERPOOL, England — Prolonged knee and hip osteoarthritis, but not hand osteoarthritis, were associated with increased cardiovascular mortality, according to findings presented here.

Aleksandra Turkiewicz, PhD, MSc, of the clinical epidemiology unit in the osteoarthritis division at Lund University in Sweden, said there have been few studies on cause-specific mortality in OA. “The aim of the present study was to estimate cause-specific mortality in doctor-diagnosed knee, hip, or hand osteoarthritis compared to the general population,” she said.

The researchers culled data from 469,152 residents of the southern region of Sweden aged 45 to 84 years in 2003. “We included almost 500,000 residents, and this was to make the confidence intervals more narrow,” Turkiewicz said.

They identified 15,901 individuals with knee OA, 9,347 with hip OA, and 4,004 with hand OA. Patients were followed from Jan. 1, 2004, through Dec. 31, 2014.

Seven major causes of mortality underwent analysis, including cardiovascular, malignant neoplasms, diabetes, infections, dementia, GI and other. The researchers also broke results into three time points: through 4 years of follow-up; 5 to 8 years of follow-up; and 9 to 11 years of follow-up.

With the exception of cardiovascular mortality, the researchers observed little evidence of increased mortality in terms of cause or OA site.

For cardiovascular mortality, there was no association through the first 4 years of follow-up, with HRs remaining below 1. However, between 5 and 8 years, the risk for cardiovascular mortality increased for patients with both knee (HR = 0.97; 95% CI, 0.89-1.03) and hip (HR = 1.11; 95% CI, 1.02-1.2) OA. Through years 9 to 11 of follow-up, the associations with cardiovascular mortality persisted for both knee (HR = 1.19; 95% CI, 1.1-1.28) and hip (HR = 1.13; 95% CI, 1.03-1.24) OA.

“These associations were driven by chronic heart diseases,” Turkiewicz said. “We observed no evidence of increased mortality from myocardial infarction in knee OA.”

She reported a similar finding for hip OA. “This was driven by chronic heart diseases but not by myocardial infarction,” she said.

Other findings indicated an increase in mortality from diabetes in patients with knee OA (HR = 1.2; 95% CI, 1.1-1.44). The researchers also observed lower mortality from cancer compared with the general population among individuals with knee OA.

“The gap in cardiovascular mortality between persons with hip and knee OA and the general population increases with duration of disease,” Turkiewicz said. “Heart failure and ischemic heart disease are of particular importance. The data also suggest we need to understand the potential association between diabetes mellitus and OA.” – by Rob Volansky

Reference:

Turkiewicz A, et al. Abstract #2. Presented at: OARSI 2018 World Congress on Osteoarthritis; April 26-29, 2018; Liverpool, England.

Disclosure: Turkiewicz reports no relevant financial disclosures.