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Joint replacement not linked to atherosclerosis.

Adults in Iceland who underwent total joint replacement of the hip or knee were not significantly more likely to have atherosclerosis, based on data from 5,170 adults with an average age of 76 years. However, women who had a total joint replacement and hand osteoarthritis were significantly more likely to have atherosclerosis, according to results that were published online.

In this study, Dr. Helgi Jonsson of the University of Iceland in Reykjavik and colleagues used total joint replacement (TJR) as an indicator of severe osteoarthritis (Ann. Rheum. Dis. 2011 [doi:10.1136/ard.2010.144980]). The population of the study included 2,195 men and 2,975 women; 539 patients had total joint replacement, including 316 with total hip replacements (THR), 223 with total knee replacements (TKR), and 31 with both hip and knee replacements.

Overall, women who had a joint replacement showed a nonsignificant trend toward increased coronary calcifications and carotid plaques, but no such associations were seen in men.

"Apart from marginally increased aortic calcium in women with TKR, there were no statistical differences in those with and without TKR and THR," the researchers noted.

But the researchers saw that there was a significant upward trend in coronary calcifications among women with hand osteoarthritis (HOA). The difference between the average value of women without either TJR or HOA and the women with both TJR and HOA was significant--approximately 10%-for three markers of atherosclerosis: coronary calcium, periventricular white matter hyperintensities, and carotid plaque.

The data were taken from a subset of older patients in the AGES (Age, Gene/Environment Susceptibility)--Reykjavik Study, a population-based study conducted in Iceland.

The results support findings from previous studies that suggest a link between osteoarthritis and atherosclerosis in women, Dr. Jonsson and associates noted.

"We are currently analyzing a number of 'midlife' biomarkers and inflammatory markers available from previous visits in the 40-year-long Reykjavik Study in an attempt to clarify this relation ship," they said.


Major Finding: Total joint replacement had no significant association with atherosclerosis in adults overall but was associated with it in women with hand OA.

Data Source: The AGES-Reykjavik Study, a population-based study of older adults with an average age of 77 years.

Disclosures: The study was funded by the National Institutes of Health, the National Institute on Aging Intramural Research Program, the Icelandic Heart Association, the Icelandic Parliament, the Icelandic Osteoarthritis Fund and the University of Iceland Research Fund. The researchers had no financial conflicts to disclose.


Focus on Early Intervention in Future Studies of OA and Atherosclerosis

It is important to study the relationships between osteoarthritis and cardiovascular health because both are chronic low-grade inflammatory diseases.

The lack of association between severe osteoarthritis and atherosclerosis in the majority of patients in this study is not surprising. We see the same thing with osteoporosis, another disease of aging in which there is low-grade inflammation, which causes a disease over time.

Genetics and diet are some factors that might affect the association between hand OA and atherosclerosis in women, which might have been factors in this study.

There are various challenges to studying the relationship between osteoarthritis and atherosclerosis, For example, it takes time to see the clinical disease and, because of that, we need to use animal models to study the relationships and try to understand both the disease mechanism and how we might intervene. When planning future studies, researchers in this area need to talk to each other and design studies to intervene before diseases become clinically apparent.

NANCY LANE, M.D., is a professor at the University of California, Davis, and director of the UC Davis Center for Healthy Aging. Her specialties include internal medicine, rheumatology, and allergy &clinical immunology. She had no financial conflicts to disclose.


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Title Annotation:RHEUMATOLOGY
Author:Splete, Heidi
Publication:Internal Medicine News
Geographic Code:4EXIC
Date:Apr 15, 2011
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