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Painful Hands, Hurting Hearts?
Symptomatic osteoarthritis (OA) of the hands was associated with an elevated risk for coronary heart disease events, analysis of data from the Framingham Heart Study showed.
In a multivariate analysis that adjusted for multiple factors including age, sex, body mass index, lipids, medication use, and smoking, the hazard ratio for coronary heart disease among individuals with symptomatic hand OA was 2.26 (95% CI 1.22-4.18, P=0.009), according to Ida K. Haugen, MD, PhD, of Diakonhjemmet Hospital in Oslo, Norway, and colleagues.
After further adjustment for physical activity, the association remained significant (HR 2.35, 95% CI 1.24-4.46), the researchers reported in the January Annals of the Rheumatic Diseases.
However, there was no association with overall mortality (HR 0.79, 95% CI 0.57-1.10, P=0.16), according to Haugen and colleagues.
Previous studies investigating cardiovascular disease and mortality rates among patients with hand OA have had inconsistent results, and while some studies have suggested an overall association, the specific types of events and causes remain uncertain.
Therefore, the researchers examined outcomes from participants in the original and offspring cohorts of the Framingham Heart Study who had hand radiographs obtained at least once during their regular examinations.
Individuals who had abnormalities detected on hand x-rays were classified as having radiographic OA, and symptomatic OA was defined as pain, aching, or stiffness in the same joints. A reference group had neither radiographic abnormalities nor symptoms.
The analysis included 276 individuals from the original cohort recruited between 1948 and 1953 and 1,072 from the offspring cohort enrolled between 1971 and 1975.
Through 2011, there had been 454 deaths among the 1,348 participants, with 243 in patients with radiographic and 75 in those with symptomatic hand OA.
There were 32 deaths per 1,000 person-years among those with radiographic OA and 28 per 1,000 for those with symptomatic OA, compared with 14 per 1,000 in those without hand OA. However, after adjustment for age, there was no difference in overall mortality.
Cardiovascular events overall, including congestive heart disease and atherothrombotic brain infarction along with coronary heart disease events, occurred more often in patients with radiographic (18 per 1,000 person-years) and symptomatic (20 per 1,000) OA than in those without OA (eight per 1,000), but in multivariate analysis there was only a trend for an association with symptomatic OA (HR 1.32, 95% CI 0.87-2.03, P=0.19).
Unlike symptomatic hand OA, the association between radiographic OA and coronary heart disease was only of borderline significance (HR 1.60, 95% CI 0.96-2.66, P=0.07).
After adjustment for painful joints in the lower limbs, the association with coronary heart disease was even stronger for symptomatic hand OA (HR 3.25, 95% CI 1.42-7.43), though less so for radiographic hand OA (HR 2.0, 95% CI 0.96-4.15).
Similar results were seen among individuals who had bilateral symptoms and greater numbers of affected joints.
In contrast, no association was seen for symptomatic hand OA and congestive heart failure (HR 1.23, 95% CI 0.71-2.13, P=0.45) or atherothrombotic stroke (HR 0.99, 95% CI 0.44-2.26, P=0.99).
This suggested that the underlying pathogenetic factors may differ, according to the authors.
Moreover, various potential mechanisms have been suggested to explain the relationship between symptomatic hand OA and coronary heart disease, but “remain speculative,” they noted.
“Several studies have demonstrated an association between obesity and hand OA, suggesting that metabolic factors (adipokines) are involved in the OA pathophysiology,” they wrote.
In addition, treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) might contribute, as these agents have been implicated in cardiovascular disease. However, the multivariate analysis adjusted for these factors.
“Established risk factors for coronary heart disease, such as unfavorable metabolic profile, NSAIDs, pain in the lower limb, or low physical activity, could not fully explain the observed association.”
Therefore, further work will be needed to identify other potential metabolic and systemic factors linking hand OA and coronary heart disease, the researchers concluded.
A limitation of the study was its exploratory nature.
From the American Heart Association:
The authors reported no financial conflicts.
Primary Source
Annals of the Rheumatic Diseases
Source Reference: Haugen I, et al “Hand osteoarthritis in relation to mortality and incidence of cardiovascular disease: data from the Framingham Heart Study” Ann Rheum Dis 2015; 74: 74-81.