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Knee and hip osteoarthritis increase the risk of cardiovascular disease: A national registry-based longitudinal cohort study
Journal article   Open access   Peer reviewed

Knee and hip osteoarthritis increase the risk of cardiovascular disease: A national registry-based longitudinal cohort study

Jeffrey J Hébert, Sinem Saritas, Parisa Niloofar, Sanja Lazarova-Molnar, Kim Christian Houlind and Niels Wedderkopp
PloS one, Vol.20(4), e0321290
2025
DOI: https://doi.org/10.1371/journal.pone.0321290
PMID: 40233039
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CC BY V4.0,  Open Access

Abstract

Adult Aged Cardiovascular Diseases - epidemiology Cardiovascular Diseases - etiology Denmark - epidemiology Female Humans Incidence Longitudinal Studies Male Middle Aged Osteoarthritis, Hip - complications Osteoarthritis, Hip - epidemiology Osteoarthritis, Knee - complications Osteoarthritis, Knee - epidemiology Proportional Hazards Models Registries Risk Factors
Objective Osteoarthritis and cardiovascular disease are major public health challenges. We aimed to estimate the average sex-specific effects of knee and hip osteoarthritis on the risk of cardiovascular disease. Methods We used 2001–2015 Danish national health registry data to identify all adults with knee or hip osteoarthritis and an age-, sex-, and education-matched group without osteoarthritis. Cardiovascular disease outcomes were identified with relevant ICD-10 codes. The effects of osteoarthritis were estimated with sex-stratified multivariable Cox regression models, accounting for multiple sources of confounding determined a priori with a directed acyclic graph. Results were reported with cumulative incidence curves and hazard ratios (HR) conditioned on age, sex, education, and obesity diagnosis. Sensitivity analyses explored the potential impacts of bias owing to outcome misclassification and unmeasured confounding. Results We analysed data from 1,838,434 adults, including 290,781 people with knee or hip osteoarthritis and 1,547,653 age-, sex-, and education-matched controls. Women with knee or hip osteoarthritis had a 44% increased hazard of cardiovascular disease (HR [95% CI] =  1.44 [1.43 to 1.46]), while men with knee or hip osteoarthritis had a 24% increased hazard of subsequent cardiovascular disease (HR[95% CI] =  1.24 [1.23 to 1.26]) compared to people without osteoarthritis. These results were confirmed by sensitivity analyses. Conclusion The apparent effect of osteoarthritis on cardiovascular disease was stronger in women than in men. Clinicians who care for patients with osteoarthritis should be aware of cardiovascular disease risk when selecting therapies and consider behavioural approaches to improving health-related physical activity behaviour in this population.

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1 Clinical & Life Sciences
1.156 Healthcare Policy
1.156.1502 Indigenous Health and Education
Web Of Science research areas
Rheumatology
ESI research areas
Clinical Medicine
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