LYON _ “Cardiovascular diseases and osteoarthritis share a number of common risk factors, such as obesity or metabolic syndrome, and cellular and molecular mechanisms, in particular via certain proteins, could be at work in both cases. However, they are still very poorly known” recalls the Dr Maxime Aurouxclinical head of rheumatology at the Édouard Herriot hospital in Lyon (HCL) and co-author of the article presented at the congress of the French Society of Rheumatology (SFR).
Cohort of 816 men
His team therefore decided to study the links between these two diseases, based on a population of men wearing prostheses for osteoarthritis. “Even if osteoarthritis is predominant in women, it is men who are particularly exposed to cardiovascular risks and the STRAMBO cohort, which we also use for other studies, only includes men,” explains the Dr. Auroux. “The STRAMBO study included 816 men aged 60 to 87, whom we followed for eight years in our unit. We compared the occurrence of adverse cardio- and cerebrovascular events (MACCE) during follow-up in patients who had at inclusion a prosthesis, either of the hip, or of the knee, or of the shoulder for osteoarthritis, with patients who didn’t have one,” he explains.
MACCE was defined as the occurrence of acute coronary syndrome (ACS) including myocardial infarction, cardiac arrest and unstable angina requiring emergency intervention, stroke or sudden death probably of cardiovascular. The events were self-reported and then confirmed by a healthcare professional.
The association between osteoarthritis and the risk of cardiovascular events was evaluated using a Cox model adjusted for age, BMI, occupational physical activity, smoking, history of myocardial infarction, hypertension, the presence of abdominal aortic calcifications, treatment with statins and treatment with vitamin K antagonists.
The average age of the patients recruited was 72 years and their average BMI was 27.6. 49 patients wore a prosthesis for osteoarthritis (18 knees, 30 hips, 6 shoulders, 6 men with 2 prostheses) and there were 767 controls. Patients wearing a prosthesis had a slightly higher BMI: 29.6 on average compared to 27.5 in those who did not wear one. They also included more diabetics (22.4% vs. 10.7% in the control group) and more frequently had a history of myocardial infarction (28.6% vs. 14.9%). On the other hand, there were no more smokers, hypertensives, or patients with a history of stroke in the osteoarthritis group than in the control group.
During follow-up, 90 men presented with MACCE, with a mean follow-up time of 51.6 months to event. “We showed a significant association between having a prosthesis for osteoarthritis and cardiovascular events, with a hazard ratio of 3.12 (confidence interval [1,74;5,58]). We wondered if this could be linked to other surgeries during follow-up, but 116 patients underwent major surgeries and their risk of MACCE did not increase compared to the others,” explains Dr. Auroux.
Significant association between wearing a prosthesis and occurrence of stroke
Men who suffered incident MACCE were older at baseline (75.2 vs. 71.8 years). They more often reported high professional physical activity, a history of myocardial infarction, and diabetes (significant after adjustment for age). On the other hand, the prevalence of a history of stroke at baseline was not different between patients who presented a MACCE during follow-up and those who did not present one.
“We then looked at each event individually. For the risk of stroke, 38 patients did so with a median follow-up time to the event of 51 months. We found a significant association between wearing a prosthesis and the occurrence of a stroke, with a hazard ratio of 4.94 (confidence interval [1,96;12,42]). On the other hand, we did not find an association for acute coronary syndrome or myocardial infarction,” specifies the rheumatologist.
“The fact that we only found stroke may be linked to a lack of power of the study, but it may also be linked to a different impact of osteoarthritis on the different types of cardiovascular events. It is possible that certain molecular mechanisms could impact cardiovascular risks differently in these cases. It would be interesting to investigate this hypothesis,” he believes.
Furthermore, he hopes that these results will be confirmed on a larger scale and also among women.
In the meantime, this study has already changed his personal practice. “From now on, in my department, when I meet patients with severe osteoarthritis, I ask them about their cardiovascular history and I recommend that they carry out screening with the cardiologist,” he confides.
For him, the message to take away from this study, not yet published, is that osteoarthritis, when it is severe, is a marker of fragility, particularly cardiovascular. “We must keep in mind this potential increase in risk,” he insists.
Links of interest of experts: None
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