Association of serum low-density lipoprotein, high-density lipoprotein, and total cholesterol with development of knee osteoarthritis

Authors: SCHWAGER, JESSICA - Boston University; NEVITT, MICHAEL - University Of California; TORNER, JAMES - University Of Iowa; LEWIS, CORA - University Of Alabama; MATTHAN, NIRUPA - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; WANG, NA - Boston University; SUN, XIANBANG - Boston University; LICHTENSTEIN, ALICE - Jean Mayer Human Nutrition Research Center On Aging At Tufts University; FELSON, DAVID - Boston University

Submitted to: Arthritis Care and Research
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/10/2020
Publication Date: 9/22/2020
Citation: Schwager, J.L., Nevitt, M.C., Torner, J., Lewis, C.E., Matthan, N.R., Wang, N., Sun, X., Lichtenstein, A.H., Felson, D. 2020. Association of serum low-density lipoprotein, high-density lipoprotein, and total cholesterol with development of knee osteoarthritis. Arthritis Care and Research. 74(2):274-280. https://doi.org/10.1002/acr.24455.
DOI: https://doi.org/10.1002/acr.24455

Interpretive Summary: Recent data have suggested an association between elevated serum cholesterol concentrations, particularly low-density lipoprotein (LDL), a risk factor for heart disease, and the development of osteoarthritis (OA). We used samples from the Multicenter Osteoarthritis study to measure plasma lipids and assess a potential relationship with OA in this cohort. Of the 337 cases of individuals reporting a disability related to OA their mean age was 62 years and a little more than half were women. No significant relation between plasma lipid concentrations and OA confirmed by x-ray or reported disability related OA was observed, for either total, LDL or HDL cholesterol. Similarly, there was no significant relation between measures of cartilage loss, worsening of worsening knee pain or joint inflammation, and total, LDL or HDL cholesterol concentrations. In conclusion, no associations were observed between plasma total, LDL or HDL cholesterol concentrates with knee OA pain or the other OA outcomes assessed.

Technical Abstract: Objective Studies suggest an association between elevated total serum cholesterol, particularly low-density lipoprotein (LDL), and osteoarthritis (OA). The present study was undertaken to evaluate the association between total cholesterol, LDL, and high-density lipoprotein (HDL) and risk of knee OA. Methods We studied participants from the Multicenter Osteoarthritis study (MOST) cohort at risk of developing knee OA. From baseline through 7 years, repeated knee radiographs and magnetic resonance images (MRIs) were obtained, and knee symptoms were queried. From baseline fasting blood samples, lipids and lipoproteins were analyzed using standard assays. After excluding participants with baseline OA, we defined 2 sets of patients: those developing radiographic OA, and those developing symptomatic OA (knee pain and radiographic OA). Controls did not develop these outcomes. Additionally, we examined worsening of cartilage loss and synovitis on MRI and of knee pain using the Western Ontario and McMaster Universities Osteoarthritis Index scale. We carried out logistic regression adjusting for age, sex, body mass index, education, baseline pain, and depressive symptoms, testing total cholesterol and lipoproteins as continuous measures, and we performed sensitivity analyses examining whether commonly used thresholds for high cholesterol, LDL, or low HDL increased risk. Results We studied 337 patients with incident symptomatic OA and 283 patients with incident radiographic OA. The mean age at baseline was 62 years (55% women). Neither total cholesterol, LDL, nor HDL showed a significant association with radiographic or symptomatic OA. Additionally, we found no association of these lipid measures with cartilage loss, worsening synovitis, or worsening knee pain. Conclusion Our data do not support an association between total cholesterol, LDL, or HDL with OA outcomes.