Abstract
The association between bone mineral density (BMD) and cardiovascular disease (CVD) is not fully understood. We evaluated BMD as a risk factor for cardiovascular disease and specifically atrial fibrillation (AF), acute myocardial infarction (AMI), ischemic (IS) and hemorrhagic stroke (HS) and heart failure (HF) in men and women. This prospective population cohort utilized data on 22 857 adults from the second and third surveys of the HUNT Study in Norway free from CVD at baseline. BMD was measured using single and dual-energy X-ray absorptiometry in the non-dominant distal forearm and T-score was calculated. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated from adjusted cox proportional hazards models. The analyses were sex-stratified, and models were adjusted for age, age-squared, BMI, physical activity, smoking status, alcohol use, and education level. Additionally, in women, we adjusted for estrogen use and postmenopause. During a mean follow-up of 13.6 ± 5.7 years, 2 928 individuals (12.8%) developed fatal or non-fatal CVD, 1 020 AF (4.5%), 1 172 AMI (5.1%), 1 389 IS (6.1%), 264 HS (1.1%), and 464 HF (2.0%). For every 1 unit decrease in BMD T-score the HR for any CVD was 1.01 (95% CI 0.98 to 1.04) in women and 0.99 (95% CI 0.94 to 1.03) in men. Point estimates for the four cardiovascular outcomes ranged from slightly protective (HR 0.95 for AF in men) to slightly deleterious (HR 1.12 for HS in men). We found no evidence of association of lower distal forearm BMD with CVD, AF, AMI, IS, HS, and HF.
Highlights
Cardiovascular disease (CVD) is a major public health problem and the main cause of loss of disability-adjusted life years and premature death globally [1, 2]
Calcification of the arterial tissue in atherosclerosis seems to be regulated by mechanisms similar to those involved in bone remodeling [4], while decreased bone mineral density (BMD) has been associated with development of atherosclerosis in elderly individuals [5]
Participants categorized as having osteoporosis were more likely to have history of fractures, lower Body mass index (BMI) and lower education, be current smokers and physically inactive (Table 1)
Summary
Cardiovascular disease (CVD) is a major public health problem and the main cause of loss of disability-adjusted life years and premature death globally [1, 2]. Calcification of the arterial tissue in atherosclerosis seems to be regulated by mechanisms similar to those involved in bone remodeling [4], while decreased bone mineral density (BMD) has been associated with development of atherosclerosis in elderly individuals [5]. Other factors such as oxidative stress, inflammation, free radicals and lipid metabolism are all involved in both bone [6, 7] and cardiovascular health [8]. To the best of our knowledge, the association with AF has not been previously investigated
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