手部、髋关节和膝关节骨关节炎与心血管事件之间的纵向关系：一项基于人群的队列研究。

The longitudinal relationship between hand, hip and knee osteoarthritis and cardiovascular events: a population-based cohort study.

机构信息

The Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada; Institute for Clinical Evaluative Sciences, Ottawa, ON, Canada; Institute for Clinical Evaluative Sciences/Sunnybrook Research Institute, Toronto, ON, Canada.

Applied Health Research Centre, The Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada.

出版信息

Osteoarthritis Cartilage. 2017 Nov;25(11):1771-1780. doi: 10.1016/j.joca.2017.07.024. Epub 2017 Aug 9.

DOI:10.1016/j.joca.2017.07.024

PMID:28801210

Abstract

OBJECTIVE

In this population-based cohort study, we examined the association between the presence of symptomatic osteoarthritis (OA) and risk for cardiovascular (CV) events.

METHOD

A cohort aged ≥55 years recruited from 1996 to 98 was followed through provincial health administrative data to 2014. Demographics, joint complaints and functional limitations were collected. Hip, knee and hand OA were defined using a validated definition. Using Cox-regressions, the relationship between OA and a composite CV outcome (myocardial infarction (MI), stroke, angina, heart failure, revascularization) was assessed controlling for age, body mass index (BMI), sex, pre-existing metabolic factors, comorbidities, income status, primary care exposure and functional limitations.

RESULTS

18,490 participants were included: median age was 68 years, 60.3% were female; 24.4% met criteria for OA (10.0% hip, 15.3% knee, 16.0% hand), 16.3% self-reported limitation in grip and 25.4% in walking. Over a median 13.4 years, 31.9% experienced a CV event. Controlling for all but walking limitation, a dose-response relationship was observed between number of joints affected by knee/hip OA and CV risk (HR 2 hips/knees vs none: 1.13, 95% CI 1.03-1.23; 3+ hips/knees: 1.22, 95% CI 1.09-1.36). This relationship became non-significant additionally controlling for difficulty walking. Self-reported difficulty walking was associated with a 30% increased hazard for CV events. The effect of hand OA was not significant.

CONCLUSION

In a large population cohort, a greater burden of hip/knee OA was associated with higher CV risk; the relationship was explained by OA-related difficulty walking. Increased attention to management of OA with a view to improving mobility has potential to reduce CV events.

摘要

目的

在这项基于人群的队列研究中，我们研究了存在症状性骨关节炎（OA）与心血管（CV）事件风险之间的关系。

方法

该队列年龄≥55 岁，于 1996 年至 98 年期间招募，通过省级卫生行政数据随访至 2014 年。收集了人口统计学、关节投诉和功能限制数据。使用经过验证的定义定义了髋、膝和手部 OA。使用 Cox 回归，在控制年龄、体重指数（BMI）、性别、预先存在的代谢因素、合并症、收入状况、初级保健暴露和功能限制的情况下，评估了 OA 与 CV 复合结局（心肌梗死（MI）、中风、心绞痛、心力衰竭、血运重建）之间的关系。

结果

共纳入 18490 名参与者：中位年龄为 68 岁，60.3%为女性；24.4%符合 OA 标准（10.0%髋部，15.3%膝部，16.0%手部），16.3%自我报告握力受限，25.4%行走受限。在中位随访 13.4 年期间，31.9%发生了 CV 事件。除行走受限外，控制所有其他因素后，膝关节/髋关节 OA 受累关节数与 CV 风险之间呈剂量反应关系（2 个髋关节/膝关节与无膝关节/髋关节相比：1.13，95%CI 1.03-1.23；3 个或更多髋关节/膝关节：1.22，95%CI 1.09-1.36）。此外，当控制行走困难时，这种关系变得不显著。自我报告的行走困难与 CV 事件的发生风险增加 30%相关。手部 OA 的影响不显著。