Background/Purpose: DISH has been reported to be associated with constitutional and metabolic derangement. In particular, patients with DISH were reported to bear a higher cardiovascular risk. The outcome of these CV risks has never been evaluated.The aim of the study was to explore if patients with DISH develop, over time, a significant cardio-vascular morbidity in a real life scenario.

Methods: This is a follow-up study on a group of patients without cardiovascular diseases. The patients’ characteristics and their CV risk factors, their prevalence of MS and their Framingham risk score has been already described. The medical records were reviewed, and the data about their current diagnoses, medical treatments, hospitalizations and mortality were re-collected. The statistical analysis compared the data with the historical data of the same groups (DISH vs non-DISH) as well as changes within the same group (DISH or non-DISH).

Results: There were 49 patients in the DISH group and 48 in the NDISH group. In this cohort, patients with DISH were significantly more often affected by type 2 diabetes, obesity, insulin resistance. They also had a significant higher risk for the development of cardiovascular events. The mean follow-up time was approximately 10 years for both groups. No differences for gender, age, age at diagnosis were observed. Patients with DISH were more often admitted to the department of medicine, the difference though did not reach statistical significance (p=0.07). More DISH patients developed acute MI (12 vs 2 p=0.0044), and were affected by hypertension and DM (60% vs 86% p=0.0049; 17% vs 54% p=0.0001respectively). The crude odds ratios for DISH patients to develop myocardial infarction during the follow-up and after adjustment for diabetes, hypertension and obesity were 7.46 (95%CI 1.57-35.44) and 5.65 (95%CI 1.08-29.43) respectively. The Framingham CV risk score under estimated the occurrence of cardiac events in particular in the DISH group. No differences were detected between the groups in the prevalence of TIA’s, CVA’s or PVD. The mortality rate between the groups was nearly equal (8.33 vs 10%). Significantly more patients in the DISH group developed de novo DM, and were prescribed ACE inhibitors, compared with the NDISH group. Increased hypertension prevalence, between the first assessment and at 10 years, was similar between the groups.

Conclusion: The incidence of MI is significantly higher in patients with DISH compared with age and sex matched NDISH patients. The increased CV risk attributed to patients with DISH is evidenced at ten years with a significant increase in myocardial infarction events during that period of time. The Framingham score under estimated the risk in patients with DISH. On the other hand, the prevalence of vascular morbidities such as TIA’s, CVA’s or PVD’s was similar between the groups. More studies are needed to determine if these findings depend only on the association of DISH with traditional CV risk factors, or, if there is a contribution of the musculoskeletal condition per se.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiovascular-events-in-patients-with-diffuse-idiopathic-skeletal-hyperostosis-a-10-years-follow-up-study/