Background/Purpose: Diffuse Idiopathic Skeletal Hyperostosis (DISH) is characterized by ossification and calcification of the entheses with prevalence increasing with age. It has been reported to be associated with obesity and type 2 diabetes mellitus (DM). The prevalence of hypertension and hyperlipidemia is also higher in patients with DISH. These factors are components of metabolic syndrome and the atherosclerotic cardiovascular disease (ASCVD) risk calculation score. Previously published studies on the association between DISH and the risk of cardiovascular events and mortality have yielded conflicting findings. Our study aimed to identify the potential association by pooling all available publications.

Methods: We comprehensively searched the databases of MEDLINE and EMBASE from inception to March 2025 to identify studies evaluating the association between DISH and the risk of cardiovascular events and mortality. We identified all observational studies that compared the incidence or risk of developing cardiovascular events in DISH patients compared to non-DISH patients. Pooled risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using a random-effects model, DerSimonian and Laird. Publication bias was analyzed with the Egger test.

Results: A total of 426 articles were identified. Following the PRISMA guidelines for study selection, 12 studies fulfilled the inclusion criteria and were included in the meta-analysis. Stratified analyses were conducted by event types: cerebrovascular accident (CVA; 8 studies), myocardial infarction/ischemic heart disease (MI/IHD; 9 studies), congestive heart failure (CHF; 6 studies), and cardiovascular mortality (3 studies).The pooled results of the present meta-analysis showed that DISH was associated with an increased risk of CVA (RR = 1.80, 95% CI: 1.59–2.05, P < 0.001; I² = 0%) and cardiovascular mortality (RR = 1.59, 95% CI: 1.21–2.09, P < 0.001; I² = 0%).However, the associations between DISH and increased risk of MI/IHD (RR = 1.59, 95% CI: 0.92–2.74, P = 0.09; I² = 80.86%) and CHF (RR = 1.07, 95% CI: 0.79–1.44, P = 0.66; I² = 23.59%) were not statistically significant. Publication bias assessed using Egger’s test showed no evidence of small-study effects (P > 0.05).

Conclusion: This analysis found that DISH is associated with a higher risk of cerebrovascular accident, but not with other cardiovascular events. Further research is needed to determine a causal relationship

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-risk-of-cardiovascular-events-and-mortality-related-to-diffuse-idiopathic-skeletal-hyperostosis-dish-a-systematic-review-and-meta-analysis/