Abstract
ARTHRITIC PAIN AS A SURROGATE MARKER FOR ASYMPTOMATIC CARDIOVASCULAR RISK FACTORS: OFFERING PRACTITIONERS A ‘TEACHABLE MOMENT’
Full text
Background: Cardiovascular diseases (CVD) are the number one cause of death worldwide. CVDs are linked to well established risk factors: obesity, hypertension (HTN), dyslipidaemia (DL) and diabetes mellitus (DM)
. While targeting risk factors reduces the burden of CVD, this is often challenging because they are largely asymptomatic and patients are therefore unlikely to seek medical attention. Arthritis, in contrast, causes pain and functional impairment prompting presentation to a healthcare practitioner. Patients with arthritis of varying aetiologies (such as osteoarthritis
, gout
, rheumatoid arthritis
) have been shown to have an increased risk of CVD.
Objectives: To examine the relationship between arthritis and DM, HTN and DL in adults of all age groups. A secondary objective was to examine whether this relationship existed independent of obesity.
Methods: Data from the 2017-18 Australian Bureau of Statistics National Health Survey included 13,776 participants, categorised into young (18-39 years), middle aged (40-64 years) and older (≥65 years) adults. Blood pressure, height and weight were measured. BMI was calculated and participants classified as obese (≥30 kg/m
) or non-obese. HTN was defined as > 140/90mmHg. Participants were asked if they had arthritis of any form, DL or DM diagnosed by a doctor. Logistic regression models estimated odds ratios with 95% CI for prevalence of arthritis associated with CVD risk factors.
Results: Arthritis was reported by 3.9% of young adults, 28.8% of middle-aged adults, and 54.5% ofolderadults. In all three age groups, arthritis was associated with significantly increased odds of obesity, HTN, DL and DM. For example, in middle-aged adults, having arthritis was associated with increased odds of obesity (1.75, 95% CI 1.54-2.01), HTN (1.78, 1.60-2.04), DL (2.14, 1.84-2.49) and DM (1.64, 1.33-2.03). These associations remained statistically significant after adjustment for obesity.
Conclusion: Compared to those without arthritis, adults with arthritis were at increased risk of obesity, HTN, DM and DL. The increased risk of HTN, DM and DL was independent of obesity and tended to be higher in younger adults. These data suggest that a patient’s presentation with symptomatic arthritis of any aetiology and at any age, may be used opportunistically as a “teachable moment” for screening for asymptomatic CVD risk factors in higher-risk individuals. This provides practitioners an opportunity to manage both arthritis and CVD risk in parallel, rather than in silos.
REFERENCES:
[1]World Health Organisation. (2017). “Cardiovascular Diseases.” from
https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases
(cvds).
[2]Wang, H., et al. (2016). “Osteoarthritis and the risk of cardiovascular disease: a meta-analysis of observational studies.” Scientific reports
6
: 39672.
[3]Singh, J. (2015). “When gout goes to the heart: does gout equal a cardiovascular disease risk factor?” Annals of the Rheumatic Diseases
74
: 631-634.
[4]England, B. R., et al. (2018). “Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications.” British Medical Journal
361
: k1036.
Table 1.
Prevalence of CVD risk factors in adults with and without arthritis.
Young
18-39 yo
Middle Aged
40-64 yo
Older
≥65 yo
No arthritis
n = 3773
Arthritis
n = 157
OR (95% CI
)
*adjusted for obesity
No arthritis
n = 4055
Arthritis
n = 1638
OR (95% CI
)
*adjusted for obesity
No arthritis
n = 1891
Arthritis
n = 2262
OR (95% CI
)
*adjusted for obesity
Obesity
473
32
2.07 (1.36-3.16)
868
527
1.75 (1.54-2.01)
326
610
1.89 (1.62-2.21)
HTN
131
14
2.72 (1.53-4.84)
2.35 (1.17-4.70)*
745
496
1.78 (1.60-2.04)
1.59 (1.37-1.84)
730
1091
1.48 (1.31-1.68)
1.35 (1.18-1.55)*
DM
19
4
5.7 (1.74-15.37)
4.87 (1.34-17.69))*
236
151
1.64 (1.33-2.03)
1.37 (1.08-1.73)*
256
399
1.37 (1.15-1.62)
1.15 (0.95-1.39)*
Disclosure of Interests: None declared
Citation: Ann Rheum Dis, volume 80, supplement 1, year 2021, page 496Session: Rheumatoid arthritis - comorbidity and clinical aspects
(POSTERS only)
3 organizations