Open Access Highly Accessed Research article

Cardiovascular disease prevalence in patients with inflammatory arthritis, diabetes mellitus and osteoarthritis: a cross-sectional study in primary care

Markus MJ Nielen1*, Alper M van Sijl2, Mike JL Peters3, Robert A Verheij1, François G Schellevis14 and Michael T Nurmohamed23

Author Affiliations

1 NIVEL (Netherlands Institute for Health Services Research), P.O. Box 1568, 3500BN, Utrecht, The Netherlands

2 Department of Rheumatology, Reade, Amsterdam, The Netherlands

3 Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands

4 Department of General Practice / EMGO Institute, VU University Medical Center, Amsterdam, The Netherlands

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BMC Musculoskeletal Disorders 2012, 13:150  doi:10.1186/1471-2474-13-150

Published: 21 August 2012



There is accumulating evidence for an increased cardiovascular burden in inflammatory arthritis, but the true magnitude of this cardiovascular burden is still debated. We sought to determine the prevalence rate of non-fatal cardiovascular disease (CVD) in inflammatory arthritis, diabetes mellitus and osteoarthritis (non-systemic inflammatory comparator) compared to controls, in primary care.


Data on CVD morbidity (ICPC codes K75 (myocardial infarction), K89 (transient ischemic attack), and/or K90 (stroke/cerebrovascular accident)) from patients with inflammatory arthritis (n = 1,518), diabetes mellitus (n = 11,959), osteoarthritis (n = 4,040) and controls (n = 158,439) were used from the Netherlands Information Network of General Practice (LINH), a large nationally representative primary care based cohort. Data were analyzed using multi-level logistic regression analyses and corrected for age, gender, hypercholesterolemia and hypertension.


CVD prevalence rates were significantly higher in inflammatory arthritis, diabetes mellitus and osteoarthritis compared with controls. These results attenuated - especially in diabetes mellitus - but remained statistically significant after adjustment for age, gender, hypertension and hypercholesterolemia for inflammatory arthritis (OR = 1.5 (1.2-1.9)) and diabetes mellitus (OR = 1.3 (1.2-1.4)). The association between osteoarthritis and CVD reversed after adjustment (OR = 0.8 (0.7-1.0)).


These results confirm an increased prevalence rate of CVD in inflammatory arthritis to levels resembling diabetes mellitus. By contrast, lack of excess CVD in osteoarthritis further suggests that the systemic inflammatory load is critical to the CVD burden in inflammatory arthritis.