POS0525 ARTHRITIC PAIN AS A SURROGATE MARKER FOR ASYMPTOMATIC CARDIOVASCULAR RISK FACTORS: OFFERING PRACTITIONERS A ‘TEACHABLE MOMENT’
Authors: J. Sewell, S. M. Hussain, Y. Wang, A. Wluka, M. Carrrington, K. Samaras, F. Cicuttini
Journal: Annals of the Rheumatic Diseases (2021)

Background: Cardiovascular diseases (CVD) are the number one cause of death worldwide. CVDs are linked to well established risk factors: obesity, hypertension (HTN), dyslipidaemia (DL) and diabetes mellitus (DM) 1 . While targeting risk factors reduces the burden of CVD, this is often challenging because they are largely asymptomatic and patients are therefore unlikely to seek medical attention. Arthritis, in contrast, causes pain and functional impairment prompting presentation to a healthcare practitioner. Patients with arthritis of varying aetiologies (such as osteoarthritis 2 , gout 3 , rheumatoid arthritis 4 ) have been shown to have an increased risk of CVD. Objectives: To examine the relationship between arthritis and DM, HTN and DL in adults of all age groups. A secondary objective was to examine whether this relationship existed independent of obesity. Methods: Data from the 2017-18 Australian Bureau of Statistics National Health Survey included 13,776 participants, categorised into young (18-39 years), middle aged (40-64 years) and older (≥65 years) adults. Blood pressure, height and weight were measured. BMI was calculated and participants classified as obese (≥30 kg/m 2 ) or non-obese. HTN was defined as &gt; 140/90mmHg. Participants were asked if they had arthritis of any form, DL or DM diagnosed by a doctor. Logistic regression models estimated odds ratios with 95% CI for prevalence of arthritis associated with CVD risk factors. Results: Arthritis was reported by 3.9% of young adults, 28.8% of middle-aged adults, and 54.5% ofolderadults. In all three age groups, arthritis was associated with significantly increased odds of obesity, HTN, DL and DM. For example, in middle-aged adults, having arthritis was associated with increased odds of obesity (1.75, 95% CI 1.54-2.01), HTN (1.78, 1.60-2.04), DL (2.14, 1.84-2.49) and DM (1.64, 1.33-2.03). These associations remained statistically significant after adjustment for obesity. Conclusion: Compared to those without arthritis, adults with arthritis were at increased risk of obesity, HTN, DM and DL. The increased risk of HTN, DM and DL was independent of obesity and tended to be higher in younger adults. These data suggest that a patient’s presentation with symptomatic arthritis of any aetiology and at any age, may be used opportunistically as a “teachable moment” for screening for asymptomatic CVD risk factors in higher-risk individuals. This provides practitioners an opportunity to manage both arthritis and CVD risk in parallel, rather than in silos. References: [1]World Health Organisation. (2017). “Cardiovascular Diseases.” from https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases (cvds). [2]Wang, H., et al. (2016). “Osteoarthritis and the risk of cardiovascular disease: a meta-analysis of observational studies.” Scientific reports 6 : 39672. [3]Singh, J. (2015). “When gout goes to the heart: does gout equal a cardiovascular disease risk factor?” Annals of the Rheumatic Diseases 74 : 631-634. [4]England, B. R., et al. (2018). “Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications.” British Medical Journal 361 : k1036. Table 1. Prevalence of CVD risk factors in adults with and without arthritis. Young 18-39 yo Middle Aged 40-64 yo Older ≥65 yo No arthritis n = 3773 Arthritis n = 157 OR (95% CI ) *adjusted for obesity No arthritis n = 4055 Arthritis n = 1638 OR (95% CI ) *adjusted for obesity No arthritis n = 1891 Arthritis n = 2262 OR (95% CI ) *adjusted for obesity Obesity 473 32 2.07 (1.36-3.16) 868 527 1.75 (1.54-2.01) 326 610 1.89 (1.62-2.21) HTN 131 14 2.72 (1.53-4.84) 2.35 (1.17-4.70)* 745 496 1.78 (1.60-2.04) 1.59 (1.37-1.84) 730 1091 1.48 (1.31-1.68) 1.35 (1.18-1.55)* DM 19 4 5.7 (1.74-15.37) 4.87 (1.34-17.69))* 236 151 1.64 (1.33-2.03) 1.37 (1.08-1.73)* 256 399 1.37 (1.15-1.62) 1.15 (0.95-1.39)* Disclosure of Interests: None declared