Constantino de Campos Gustavo, Mundi Raman, Whittington Craig, Toutounji Marie-Josée, Ngai Wilson, Sheehan Brendan
Department of Orthopedic Surgery, Faculty of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), PO Box 6111, Campinas, São Paulo 13087-000, Brazil.
Sunnybrook Health Sciences Centre, ON, Canada.
Ther Adv Musculoskelet Dis. 2020 Dec 25;12:1759720X20981219. doi: 10.1177/1759720X20981219. eCollection 2020.
The objective of this review was to examine the relationship between osteoarthritis (OA) and mobility-related comorbidities, specifically diabetes mellitus (DM) and cardiovascular disease (CVD). It also investigated the relationship between OA and mortality.
An overview of meta-analyses was conducted by performing two targeted searches from inception to June 2020. The association between OA and (i) DM or CVD ( PubMed and Embase); and (ii) mortality ( PubMed) was investigated. Meta-analyses were selected if they included studies that examined adults with OA at any site and reported associations between OA and DM, CVD, or mortality. Evidence was synthesized qualitatively.
Six meta-analyses met inclusion criteria. One meta-analysis of 20 studies demonstrated a statistically significant association between OA and DM, with pooled odds ratio of 1.41 (95% confidence interval: 1.21, 1.65; = 1,040,175 patients). One meta-analysis of 15 studies demonstrated significantly increased risk of CVD among OA patients, with a pooled risk ratio of 1.24 (1.12, 1.37, = 358,944 patients). Stratified by type of CVD, OA was shown to be associated with increased heart failure (HF) and ischemic heart disease (IHD) and reduced transient ischemic attack (TIA). There was no association reported for stroke or myocardial infarction (MI). Three meta-analyses did not find a significant association between OA (any site) and all-cause mortality. However, OA was found to be significantly associated with cardiovascular-related death across two meta-analyses.
The identified meta-analyses reported significantly increased risk of both DM and CVD (particularly, HF and IHD) among OA patients. It was not possible to confirm consistent directional or causal relationships. OA was found to be associated with increased mortality, but mostly in relation to CVD-related mortality, suggesting that further study is warranted in this area.
本综述的目的是研究骨关节炎（OA）与 mobility-related 合并症之间的关系，特别是糖尿病（DM）和心血管疾病（CVD）。它还研究了OA与死亡率之间的关系。
通过从开始到2020年6月进行两次针对性搜索，对荟萃分析进行了概述。研究了OA与（i）DM或CVD（PubMed和Embase）；以及（ii）死亡率（PubMed）之间的关联。如果荟萃分析包括检查任何部位OA成人并报告OA与DM、CVD或死亡率之间关联的研究，则选择这些荟萃分析。对证据进行定性综合。
六项荟萃分析符合纳入标准。一项对20项研究的荟萃分析表明，OA与DM之间存在统计学上显著的关联，合并比值比为1.41（95%置信区间：1.21, 1.65；n = 1,040,175例患者）。一项对15项研究的荟萃分析表明，OA患者中CVD风险显著增加，合并风险比为1.24（1.12, 1.37；n = 358,944例患者）。按CVD类型分层，OA与心力衰竭（HF）和缺血性心脏病（IHD）增加以及短暂性脑缺血发作（TIA）减少相关。未报告与中风或心肌梗死（MI）的关联。三项荟萃分析未发现OA（任何部位）与全因死亡率之间存在显著关联。然而，在两项荟萃分析中发现OA与心血管相关死亡显著相关。
已确定的荟萃分析报告称，OA患者中DM和CVD（特别是HF和IHD）的风险显著增加。无法确认一致的方向性或因果关系。发现OA与死亡率增加相关，但主要与CVD相关死亡率有关，这表明该领域有必要进一步研究。
