Related Experiment Video
Updated: Dec 11, 2025
Standardized Histomorphometric Evaluation of Osteoarthritis in a Surgical Mouse Model
Published on: May 6, 2020
Cardiovascular disease in diffuse idiopathic skeletal hyperostosis (DISH): from theory to reality-a 10-year follow-up
Karina Glick1, Irina Novofastovski2, Naama Schwartz3
1Department of Medicine A, Assuta University Hospital, Ben-Gurion University of the Negev Faculty of Health Sciences, Ashdod, Israel.
Insights
Patients with diffuse idiopathic skeletal hyperostosis (DISH) have a higher risk of cardiovascular events, particularly myocardial infarction (MI), than predicted by the Framingham score. This highlights the need for aggressive primary prevention strategies in this population.
Area of Science:
- Cardiovascular Medicine
- Rheumatology
- Epidemiology
Background:
- Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by widespread calcification of ligaments and tendons.
- The cardiovascular implications of DISH, especially in patients without pre-existing cardiovascular disease (CVD), are not fully understood.
- Existing risk assessment tools may not accurately capture the CVD risk in individuals with DISH.
Purpose of the Study:
- To investigate the incidence of actual cardiovascular events over a decade in patients diagnosed with DISH.
- To compare the observed cardiovascular event rates in DISH patients against predicted risks using the Framingham score.
- To identify specific cardiovascular outcomes that are more prevalent in the DISH cohort.
Main Methods:
- Retrospective review of medical records for patients with DISH and matched controls, starting from 2006.
- Collection of demographic, constitutional, and laboratory data.
- Comparison of cardiovascular events, including coronary events, myocardial infarction (MI), coronary death, congestive heart failure, and angina pectoris, based on Framingham score 2 definitions.
Main Results:
- Nearly 39% of DISH patients developed cardiovascular disease (CVD) over 10 years, exceeding the 28.6% predicted by the Framingham score.
- The incidence of myocardial infarction (MI) was significantly higher in the DISH group compared to controls (P=0.005).
- The DISH group exhibited higher overall morbidity with a composite outcome of 38.8% versus 25.5% in the control cohort.
Conclusions:
- The Framingham score underestimates the actual cardiovascular risk, particularly for MI, in patients with DISH.
- Increased vigilance in evaluating cardiovascular risk is recommended for patients with DISH.
- Earlier and more aggressive medical interventions, including primary prevention strategies, are warranted for individuals with DISH.
Objective:
To describe actual cardiovascular events over a decade in patients with diffuse idiopathic skeletal hyperostosis (DISH), without previously known CV diseases.
Methods:
The medical records of patients with DISH and controls, beginning in 2006 (without known CV disease), were reviewed. Demographic, constitutional, and laboratory data were collected. Comparison of CV events following 2006 was performed according to the outcome definitions set by the Framingham score 2: coronary event demonstrated by a coronary imaging modality, acute myocardial infarction (MI), coronary death, congestive heart failure with a reduced ejection fraction, and angina pectoris.
Results:
Data were available for 45 patients with DISH and 47 controls without DISH from the original cohort (91.8% and 97.9% respectively). By the Framingham score, 28.6% (± 20.33) of the DISH patients were expected to be affected with CVD at 10 years of follow-up. We observed that nearly 39% of them developed CVD during that period (95% CI 23.8-53.5%). The incidence of MI over the 10-year period was significantly higher in the DISH group (P = 0.005). The DISH group had higher morbidity with a higher composite outcome of 38.8% vs 25.5% in the control cohort, and the number of non-elective hospital admissions per patient, despite neither reaching statistical significance.
Conclusion:
Our study showed that the Framingham score underestimates the real risk for developing CVD in patients with DISH, specifically the risk for MI. We propose more scrutiny is warranted in evaluating CV risk in these patients, more demanding treatment target goals should be established, and earlier and more aggressive medical interventions should be undertaken, particularly primary prevention. Larger prospective studies are needed to corroborate these findings.
Related Concept Videos
01:22Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies
01:29Bone Disorders
Bone deposition is also affected by the levels of sex hormones like estrogen and testosterone that promote osteoblast activity and bone matrix synthesis. When the level of these hormones decreases due to aging, it causes a reduction in bone deposition. As a result, bone resorption by osteoclasts...
01:23Rheumatic Heart Disease I: Introduction
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:22Connective Tissue Cell Types
Fat cells (adipocytes), smooth muscle cells (myoblasts), and bone cells (osteoblasts) are some connective tissue cell types. Some immune system cells...
01:27Growth of Cartilage and Bone Tissue