Osteoarthritis May Raise Heart Disease Risk
Studies suggest a connection between OA and cardiovascular disease. Decrease your risk with these helpful tips.
Osteoarthritis is characterized by breakdown of the cartilage that cushions the ends of the bones where they meet to form joints. Scientists are now learning that having OA can mean more than joint problems. Research shows that people with OA may be at increased risk of cardiovascular disease (CVD).
In a study published in December 2013 issue of Arthritis Care & Research, Canadian researchers found that women and older men with knee or hip OA were more likely to be hospitalized for heart problems than those without arthritis.
Patients in the study were selected from a sample population of people registered in a large Canadian Ministry of Health database. A total of 12,745 patients with diagnosed OA were matched with nearly 37,000 people who did not have arthritis. Sixty percent were women, the average age was 58 and none had CVD before the study.
In comparing the two groups, researchers took into account factors that could influence heart disease risk, including age, sex, socioeconomic status and health conditions such as high blood pressure, high cholesterol and diabetes. The database did not contain information about body mass index (BMI), so this was estimated using statistics from a large Canadian health survey.
Patients were followed for an average of 13 years. In that time, nearly 8,000 were hospitalized for various types of heart disease, including heart attack, congestive heart failure and stroke. Analysis of the data showed having OA increased the risk of hospitalization for CVD in women of all ages and in men 65 and older compared with their counterparts who didn’t have OA. The estimated increased risk was 23 percent among women younger than 65 years, 17 percent among older women and 15 percent among older men. No increased risk was seen for men younger than 65.
That large study was not the first to show a link between the two diseases.
Finnish researchers first noted a connection between OA and cardiovascular disease in a 2003 study published in Annals of the Rheumatic Diseases. The researchers, who followed 7,000 people for 15 years, found that men who had osteoarthritis in any finger joint were 40 percent more likely to die of heart disease than were men without arthritis in any fingers. Women with OA in a finger joint were 23 percent more likely to die of heart disease.
Another study reported in 2012 in Family Practice News found that in women younger than 65, osteoarthritis was associated with a 41 percent increase in heart disease risk. For men the increase was more modest, although the researchers don’t know why. Nor do they understand completely why people with osteoarthritis would have an increased risk of heart disease. However, there are a number of plausible explanations researchers are pursuing.
What Links OA and Heart Disease?
Decreased physical activity. Physical activity is crucial for a healthy heart, but stiff, painful joints make it difficult for people with OA to be active.
Obesity. Obesity is a factor in both OA and CVD, largely because carrying excess body weight puts stress on both the joints and heart, which can cause damage over time. Fat cells also produce substances harmful to joints, the heart and blood vessels.
Diabetes. A 2012 study published in Diabetes Care found that having type-II diabetes more than doubles the risk of developing OA severe enough to require joint replacement. Studies also show having type-II diabetes raises your risk of heart attack to that of someone who has had a previous heart attack.
NSAID use. Studies show using a nonsteroidal anti-inflammatory drug (NSAID) such as ibuprofen (Advil, Motrin) or naproxen (Aleve, Naprosyn) to relieve osteoarthritis pain may increase cardiovascular risk. The largest such study, published in the British Medical Journal in 2011, pooled data from 31 clinical trials with a total of more than 116,000 participants. It concluded that for people who took NSAIDs regularly, the drugs significantly increased the risk of cardiovascular events, including heart attack and stroke. Depending on the particular NSAID, the risk of death from a cardiovascular event was up to four times that of people not taking NSAIDs.
How Can You Protect Your Heart?
The 2013 study published in Arthritis Care & Research showed the risk of CVD was greatest for patients with OA severe enough to require joint replacement. A separate Canadian study published in 2013 in the British Medical Journal showed that in the long-term, having joint replacement was protective against serious cardiovascular events in people with moderate-to-severe osteoarthritis.
“We hypothesized that joint replacement would allow for increased physical activity, and remove the [point or origin] of inflammation, which may be reflected with a decrease in CV events in persons with severe OA that received a joint replacement versus those that did not,” says the study’s lead author, Bheeshma Ravi, MD, a resident in orthopaedic surgery at the University of Toronto.
Dr. Ravi and colleagues followed 2,200 adults with hip or knee osteoarthritis who were 55 or older at recruitment (1996-98) until death or 2011. Over a median of seven years after the start of the study, participants who underwent a total joint replacement were significantly less likely than those who did not to experience a cardiovascular event. “After controlling for several potential confounders, including baseline CV disease, we found that [receiving a total joint replacement] was associated with a 33 percent reduction in the risk for subsequent CV events,” says Dr. Ravi.
Even as researchers work to better understand the OA/CVD connection, this and other research suggests there are many things people with OA can do to reduce their cardiovascular risk, including maintaining a healthy weight, exercising, managing diabetes, and speaking with their doctor about alternative medications to NSAIDs, if appropriate. “And don't wait until your arthritis completely debilitates you before talking to your doctor about a joint replacement,” says Dr. Ravi. “Understand, however, that this surgery is not without risk, especially in those with underlying cardiovascular disease.”
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