Associations between cardiovascular disease severity, osteoarthritis co-morbidity and physical health: a
James A Prior1, Kelvin P Jordan2, Umesh T Kadam3
1Research Institute for Primary Care and Health Sciences and Health Services Research Unit, Keele University, Keele, UK. j.a.prior@keele.ac.uk.
Insights
The addition of osteoarthritis (OA) to cardiovascular disease (CVD) incrementally worsens physical health. While OA exacerbates physical health decline in CVD patients, the combined impact is less than the sum of individual effects.
Area of Science:
- Cardiovascular health
- Rheumatology
- Public health
Background:
- Cardiovascular disease (CVD) and osteoarthritis (OA) are prevalent chronic conditions.
- The combined impact of CVD severity and OA comorbidity on physical health is not fully understood.
Purpose of the Study:
- To investigate the interaction between cardiovascular disease severity and osteoarthritis comorbidity on physical health outcomes.
Main Methods:
- A cohort of 9676 patients aged ≥40 years from UK family practices was surveyed.
- Patients were categorized into groups based on the presence and severity of cardiovascular disease and osteoarthritis.
- Physical health was assessed using the 12-item Short Form Health Survey (SF-12) physical component summary (PCS) score.
Main Results:
- A total of 5426 patients responded (56% response rate).
- Cardiovascular disease alone significantly reduced PCS scores, with heart failure having the largest impact (-11.8).
- Osteoarthritis alone also reduced PCS scores (-5.6).
- Co-morbidity with OA further decreased PCS scores across all CVD severities, with the most severe impact seen in heart failure with OA (-12.8).
Conclusions:
- The co-morbid addition of osteoarthritis to cardiovascular disease is associated with incrementally poorer physical health.
- These interactions are less than additive, suggesting a complex relationship between OA and CVD impact on physical function.
Objective:
The aim of this study was to investigate the interaction between cardiovascular disease severity and OA co-morbidity on physical health.
Methods:
A baseline questionnaire was mailed to 9676 patients aged ≥40 years from UK family practices. A priori exclusive morbidity groups were constructed as follows, based on records 3 years before baseline: (i) reference group--neither cardiovascular disease nor OA; (ii) cardiovascular disease severity index groups--with hypertension, ischaemic heart disease or heart failure without OA; (iii) OA index group without cardiovascular disease and (iv) co-morbid severity groups with hypertension, ischaemic heart disease or heart failure with OA. Adjusted associations between morbidity groups and physical health [mean physical component summary (PCS) score based on the 12-item Short Form Health Survey (SF-12)] compared with the reference group were assessed using linear regression methods.
Results:
A total of 5426 patients responded to the baseline questionnaire (56% response). The adjusted mean difference in PCS score between the reference group and the cardiovascular disease index were -2.4 (95% CI -3.4, -1.4) for hypertension, -5.3 (-6.3, -4.3) for ischaemic heart disease and -11.8 (-13.6, -9.9) for heart failure. The difference in the score for the index OA group was -5.6 (-6.5, -4.6). Estimates for co-morbid OA groups were -6.8 (-7.9, -5.7) for hypertension, -9.1 (-10.6, -7.6) for ischaemic heart disease and -12.8 (-16.0, -9.7) for heart failure.
Conclusion:
In cardiovascular populations with differing severity, the co-morbid addition of OA was associated with incrementally poorer physical health, but such interactions were less than additive.
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