Reachout Orthopedics - Issue 1

CVD is again controversial. Some cross-sec- tional studies, in fact, have shown that hand OA is associated with a higher presence of CVD, also in pre-clinical forms. For example in a study involving 5,342 older participants, hand OA was associated with a significant higher presence of carotid plaques, coro- nary and aortic calcifications, particularly in women [22]. It is known that hand OA is linked to the menopause more strongly than other sites [23] and the subsequent decrease in circulating endogenous estrogens, a feature which has also been linked to an increase in CVD rate [24]. However, some longitudinal studies have shown that hand OA was not associated with higher risk of CVD onset [12, 25]. Therefore, other studies are needed to disentangle this topic. When we analyzed our data separately by gender, OAonly emerged as a significant CVD risk factor only in women, in agreement with the literature regarding this topic [26]. Even if why the association between OA and CVD is significant only in women is unclear. One hypothesis is that women make more use of analgesic drugs for these conditions thanmen, because they are more sensitive to pain [17]. Since these drugs have an unfavorable CVD profile, it is likely that this factor may play a role. Another possible explanation could be extracellular matrix (ECM) remodeling after menopause since, before this period of life, women are at decreased CVD risk than men. It is known that ECM is altered in OA (particularly in the cartilage joints) [27], but this process probably involves also arteries and heart [9]. Since after menopause the alterations of ECM is more rapid in women than men due to the loss of estrogens [24], it may be that these changes make the onset of CVD more likely in women than in men. Third, other researches have proposed that other pathways are probably involved in this gender difference, e.g. tool-like receptors (TLRs) pathways are more altered in post- menopausal women than men [28], and play a part in both OA [29] and CVD [28]. Finally, we should acknowledge that men are less represented in the OAI than women and so a type II error for analyses regarding men is possible. Our findings should be considered within the limitations of our study. First, as mentioned before, the diagnosis of OA was self-reported, except for knee OA. Second, also the diagnosis of CVD and the comorbidities was self-reported and this could create a bias. The lack of data regarding medications could introduce another bias: for example, we found a prevalence of hypertension of 20%, whilst in people aging about 60 years it is estimated in about 50% [30]. Similarly, some drugs commonly used in the elderly (e.g. duloxetine) that could increase the risk of hypertension were not used as potential confounders in our analyses. Third, we don’t have any information regarding CVD mortality and other cardiovascular events, such as hospitalization for CVD, that our recent research has shown been associated with the presence of OA [12]. Fifth, people with OA at the baseline had already a higher prevalence of several CVD risk factors that could increase the risk of incident CVD. Although we have adjusted our analyses for all these factors, a selection bias could be not excluded. Finally, we did not assess any inflammatory marker, although inflammation could be associated with higher CVD risk [31]. Nonetheless, allowing for these caveats, our study involves a large population and the follow-up period seems to be appropriate for our outcome of interest. Moreover, we adjusted our analyses for multiple important confounders, thus strengthening our results. In conclusion, our study demonstrated that people with OA are significantly associated with an increased risk of the onset of CVD in middle-aged and older participants over an eight-year period. Since some interventions aiming to improve OA symptoms (e.g. increasing physical activity andweight loss reduction) seem to be effective from a cardiological perspective, further studies are needed to better understand if to treat OA is able to decrease CVD risk in these individuals. Conflict of interest: The authors declare that there is no conflict of interest. Funding sources: The OAI is a public-private partnership comprised of five contracts(N01-AR-2-2258; N01-AR- 2-2259; N01-AR-2-2260; N01-AR-2-2261; N01-AR- 2-2262)funded by the National Institutes of Health, a branch of the Department of Health and Human Services, and conducted by the OAI Study Investigators. Private funding partners include Merck Research Laboratories; Novartis Pharmaceuticals Corporation, GlaxoSmithKline; and Pfizer, Inc. Private sector funding for the OAI is managed by the Foundation for the National Institutes of Health. This manuscript was prepared using an OAI public use data set and does not necessarily reflect the opinions or views of the OAI investigators, the NIH, or the private funding partners. Role of founding source: The funding sources did not have any role in in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. Ethical standard: This study was conducted according to the guidelines laid down in the Declaration of Helsinki (2008, including 2013 amendments) and all procedures were approved by the University Research Ethics Committee. Written informed consent was obtained from all participants. No animals were used in this study. References available on request Healthcare.India@springer.com Source: N. Veronese, B. Stubbs, M. Solmi, et al . Osteoarthritis increases the risk of cardiovascular disease: data from the osteoarthritis initiative. J Nutr Health Aging. 2018; 22(3):371–376. DOI 10.1007/s12603-017-0941-0. © Serdi and Springer-Verlag France SAS, part of Springer Nature 2017. Our study demonstrated that people with OA are significantly associated with an increased risk of the onset of CVD in middle-aged and older participants over an eight-year period. 27 reachOut Orthopedics