Abstract
BackgroundBecause individuals with osteoarthritis (OA) avoid physical activities that exacerbate symptoms, potentially increasing risk for cardiovascular disease (CVD) and death, we assessed the relationship between OA disability and these outcomes.MethodsIn a population cohort aged 55+ years with at least moderately severe symptomatic hip and/or knee OA, OA disability (Western Ontario McMaster Universities (WOMAC) OA scores; Health Assessment Questionnaire (HAQ) walking score; use of walking aids) and other covariates were assessed by questionnaire. Survey data were linked to health administrative data to determine the relationship between baseline OA symptom severity to all-cause mortality and occurrence of a composite CVD outcome (acute myocardial infarction, coronary revascularization, heart failure, stroke or transient ischemic attack) over a median follow-up of 13.2 and 9.2 years, respectively.ResultsOf 2156 participants, 1,236 (57.3%) died and 822 (38.1%) experienced a CVD outcome during follow-up. Higher (worse) baseline WOMAC function scores and walking disability were independently associated with a higher all-cause mortality (adjusted hazard ratio, aHR, per 10-point increase in WOMAC function score 1.04, 95% confidence interval, CI 1.01–1.07, p = 0.004; aHR per unit increase in HAQ walking score 1.30, 95% CI 1.22–1.39, p<0.001; and aHR for those using versus not using a walking aid 1.51, 95% CI 1.34–1.70, p<0.001). In survival analysis, censoring on death, risk of our composite CVD outcome was also significantly and independently associated with greater baseline walking disability ((aHR for use of a walking aid = 1.27, 95% CI 1.10–1.47, p = 0.001; aHR per unit increase in HAQ walking score = 1.17, 95% CI 1.08–1.27, p<0.001).ConclusionsAmong individuals with hip and/or knee OA, severity of OA disability was associated with a significant increase in all-cause mortality and serious CVD events after controlling for multiple confounders. Research is needed to elucidate modifiable mechanisms.
Highlights
Aging populations and the growing prevalence of obesity [1,2] have led to increased population risk for hypertension [3,4], dyslipidemia [5], diabetes [6], and cardiovascular disease (CVD) [7]
OA is under-diagnosed and under-treated. This is in part due to the high co-prevalence of other chronic conditions in people with OA; 90% are estimated to have at least one additional chronic condition [12], with OA and CVD among the most common dyads seen in clinical practice
We have previously shown that, in the absence of receipt of total joint arthroplasty (TJA), people with hip and knee OA experience worsening of their functional limitations over time [28,29]; receipt of primary, elective TJA of the hip or knee is associated with significant improvement in OA pain and walking disability
Summary
Aging populations and the growing prevalence of obesity [1,2] have led to increased population risk for hypertension [3,4], dyslipidemia [5], diabetes [6], and cardiovascular disease (CVD) [7]. OA management focuses on pain relief and preserving physical function [11] using non-pharmacologic and pharmacologic therapies and, joint replacement surgery. This is in part due to the high co-prevalence of other chronic conditions in people with OA; 90% are estimated to have at least one additional chronic condition [12], with OA and CVD among the most common dyads seen in clinical practice. Because individuals with osteoarthritis (OA) avoid physical activities that exacerbate symptoms, potentially increasing risk for cardiovascular disease (CVD) and death, we assessed the relationship between OA disability and these outcomes
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