Background/Purpose: While cross-sectional evidence points to a higher prevalence of cardiovascular (CVD) risk factors in persons with arthritis, longitudinal population based studies are lacking. The objective of the present study was to estimate the incidence of major CVD risk factors (obesity, diabetes and high blood pressure) associated with arthritis in a longitudinal population-based survey. 

Methods: The present study was a secondary analysis of the Canadian National Population Health Survey (NPHS), a longitudinal study of 17,276 Canadians followed-up every 2 years from 1994/95 through 2010/11. Survey participants provided updated information on socio-demographic variables, self-reported physician-diagnosed chronic conditions (including arthritis, high blood pressure and diabetes), and lifestyle/health behaviors, including height & weight used to calculate body mass index (BMI) classification of obesity. Cause of death records for diabetes (ICD10 codes:E10-E14) and hypertension (ICD10 codes I10-I15) were confirmed against the Canadian Vital Statistics Database. Adult participants age 18+ and at-risk for each risk factor (i.e. those without a prior history of, or prevalent report of each risk factor at the 1994/95 baseline assessment) were eligible for analysis. Adjusted odds ratios and 95% confidence intervals (CI) conveying the odds of experiencing each risk factor event in a given time period conditional on not having experienced the event before were estimated using separate discrete time survival models. Each model included repeated measures of arthritis updated every 2 years and the following baseline covariates: age sex, race, education, smoking, physical activity, BMI, alcohol consumption, non-CVD comorbidity index, and use of pain medications. All analyses were carried out using appropriate survey weights and bootstrap standard errors to account for the complex survey design.

Results: We identified 2,284, 3,022 and 1,045 incident obesity, high blood pressure and diabetes events during the study follow up period from 1996/97 through 2010/2011. Adjusting for age and sex, arthritis was significantly associated with increased risks of each of the 3 risk factors (obesity OR (95% CI): 1.39 (1.22-1.60), high blood pressure OR (95% CI): 1.30 (1.17-1.45) and diabetes OR (95% CI): 1.25 (1.03-1.52)). In fully adjusted models controlling for all covariates, results were attenuated but remained significant for obesity (OR (95% CI): 1.20 (1.02-1.42)) and high blood pressure (OR (95% CI): 1.19 (1.05-1.34.)) but not for diabetes (OR (95% CI): 0.97 (0.83-1.12)).

Conclusion: Results of this nationally representative Canadian population based study showed that persons with arthritis had increased risks for developing major CVD risk factors. The current findings not only support arthritis as a flag for screening for existing CVD risk factors but suggest that the disease itself, its treatment and/or its consequences (i.e. pain and disability) may be implicated in the onset of obesity and high blood pressure in persons at risk for developing these conditions.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/incidence-of-obesity-diabetes-and-high-blood-pressure-associated-with-arthritis-analysis-of-the-canadian-longitudinal-national-population-health-survey/