Hyperlipidemia Is a Risk Factor of Adhesive Capsulitis: Real-World Evidence Using the Taiwanese National Health Insurance Research Database

Jr-Yi Wang; Chen-Kun Liaw; Chi-Chang Huang; Tsan-Hon Liou; Hui-Wen Lin; Shih-Wei Huang

doi:10.1177/2325967120986808

Hyperlipidemia Is a Risk Factor of Adhesive Capsulitis: Real-World Evidence Using the Taiwanese National Health Insurance Research Database

Orthop J Sports Med. 2021 Apr 5;9(4):2325967120986808. doi: 10.1177/2325967120986808. eCollection 2021 Apr.

Authors

Jr-Yi Wang^{1

2}, Chen-Kun Liaw^{1

2}, Chi-Chang Huang³, Tsan-Hon Liou^{4

5}, Hui-Wen Lin^{6

7}, Shih-Wei Huang^{3

4

5}

Affiliations

¹ Department of Orthopedic Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City.
² Department of Orthopedics, School of Medicine, College of Medicine, Taipei Medical University, Taipei.
³ Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan.
⁴ Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei.
⁵ Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University.
⁶ Department of Mathematics, Soochow University, Taipei.
⁷ ICF Research Center, Shuang Ho Hospital, Taipei Medical University, Taipei.

Abstract

Background: Patients with adhesive capsulitis are evaluated for pain and progressive contracture of the glenohumeral joint. Whether endocrine, immune, or inflammatory processes are involved in its definite pathogenesis is still under debate. Some cross-sectional studies with a small sample size have noted that hyperlipidemia is a possible risk factor for frozen shoulders.

Purpose/hypothesis: The purpose was to conduct a longitudinal population-based study to investigate the risk of adhesive capsulitis among patients with hyperlipidemia. It was hypothesized that patients with hyperlipidemia would have a higher risk of adhesive capsulitis and that the use of statin drugs could reduce the rate.

Study design: Cohort study; Level of evidence, 3.

Methods: Using data from the National Health Insurance Research Database (NHIRD) of Taiwan, the authors obtained the records of patients with hyperlipidemia who received a diagnosis between 2004 and 2005 and were followed up until the end of 2010. The control cohort comprised age- and sex-matched patients without hyperlipidemia. Propensity score matching was performed for the other comorbidities. A Cox multivariate proportional hazards model was applied to analyze the risk factors of adhesive capsulitis. The hazard ratio (HR) and adjusted HR were estimated between the study and control cohorts after adjustment for confounders. The effects of statin use on adhesive capsulitis risk were also analyzed.

Results: The NHIRD records of 28,748 patients and 114,992 propensity score-matched controls were evaluated. A higher incidence rate of adhesive capsulitis was revealed in the hyperlipidemia cohort, with a crude HR of 1.70 (95% CI, 1.61-1.79; P < .001) and adjusted HR of 1.50 (95% CI, 1.41-1.59; P < .001). Patients with hyperlipidemia who used a statin still had higher crude and adjusted HRs compared with controls. Statin use did not exert protective effects on patients with hyperlipidemia.

Conclusion: Patients with hyperlipidemia had a 1.5-fold higher risk of adhesive capsulitis than did healthy controls. Statin use did not provide protection against adhesive capsulitis in patients with hyperlipidemia.

Keywords: adhesive capsulitis; frozen shoulder; hyperlipidemia; population-based study.