Bone mineral density and risk of cardiovascular disease in men and women: the HUNT study

Bhatta, Laxmi; Cepelis, Aivaras; Vikjord, Sigrid Anna Aalberg; Malmo, Vegard; Laugsand, Lars Erik; Dalen, Håvard; Janszky, Imre; Strand, Linn Beate; Brumpton, Ben

doi:10.1007/s10654-021-00803-y

Cited by 12 publications

(5 citation statements)

References 53 publications

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“…Higher eBMD was more protective against incident CVDs in women compared to men, particularly for IHD, HF, and arrhythmia. This is in contrast to the HUNT study, 30 which showed a small protective association of BMD on MI and AF in men but not in the female population. Conversely, the research conducted by Yang et al.…”

Section: Discussioncontrasting

confidence: 99%

Bone health, cardiovascular disease, and imaging outcomes in UK Biobank: a causal analysis

Condurache,

D’Angelo,

Salih

et al. 2024

JBMR Plus

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This study examined the association of estimated heel bone mineral density (eBMD, derived from quantitative ultrasound) with: 1) prevalent and incident cardiovascular diseases (CVDs: ischaemic heart disease (IHD), myocardial infarction (MI), heart failure, non-ischaemic cardiomyopathy (NICM), arrhythmia), 2) mortality (all-cause, CVD, IHD), and 3) cardiovascular magnetic resonance (CMR) measures of left ventricular and atrial structure and function and aortic distensibility, in the UK Biobank. Clinical outcomes were ascertained using health record linkage over 12.3 years of prospective follow-up. Two-sample Mendelian randomization (MR) was conducted to assess causal associations between BMD and CMR metrics using genetic instrumental variables identified from published genome-wide association studies. The analysis included 485 257 participants (55% women, mean age 56.5 ± 8.1 years). Higher heel eBMD was associated with lower odds of all prevalent CVDs considered. The greatest magnitude of effect was seen in association with heart failure and NICM, where 1-SD increase in eBMD was associated with 15% lower odds of heart failure and 16% lower odds of NICM. Association between eBMD and incident IHD and MI were non-significant; the strongest relationship was with incident heart failure (SHR: 0.90 [95% CI: 0.89-0.92]). Higher eBMD was associated with a decreased risk in all-cause, CVD, and IHD mortality, in the fully adjusted model. Higher eBMD was associated with greater aortic distensibility; associations with other CMR metrics were null. Higher heel eBMD is linked to reduced risk of a range of prevalent and incident CVD and mortality outcomes. While observational analyses suggest associations between higher eBMD and greater aortic compliance, MR analysis did not support a causal relationship between genetically predicted BMD and CMR phenotypes. These findings support the notion that bone-cardiovascular associations reflect shared risk factors/mechanisms rather than direct causal pathways.

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Section: Discussioncontrasting

confidence: 99%

Bone health, cardiovascular disease, and imaging outcomes in UK Biobank: a causal analysis

Condurache,

D’Angelo,

Salih

et al. 2024

JBMR Plus

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“…More recently, the HUNT study did not find an association between forearm BMD and new-onset HF in European men or women, although ascertainment of HF cases based on diagnostic coding was not validated, and events in men were relatively modest in number. 27 The present investigation in Health ABC, which includes >4-fold Black individuals as the prior CHS report, newly reveals an inverse association between areal BMD of the hip, as well as volumetric BMD of the spine, and incident HF in Black women. The current analysis also confirms the positive relationship between hip BMD and new-onset HF in Black men observed in CHS.…”

Section: Prior Studiesmentioning

confidence: 52%

“…Our prior work in CHS 17 evaluated BMD of the hip, detecting effect modification by both sex and race: a significant association was observed in male but not female participants, wherein lower BMD was associated with higher incidence of HF in White men, but lower incidence of HF in Black men. More recently, the HUNT study did not find an association between forearm BMD and new‐onset HF in European men or women, although ascertainment of HF cases based on diagnostic coding was not validated, and events in men were relatively modest in number 27 …”

Section: Discussionmentioning

confidence: 99%

Sex‐ and race‐specific associations of bone mineral density with incident heart failure and its subtypes in older adults

Gao

Patel

Fohtung

et al. 2022

J American Geriatrics Society

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Background: Previous studies have suggested an association between bone mineral density (BMD) and heart failure (HF) risk that may be racedependent. Methods:We evaluated the relationship between BMD and incident HF in a cohort of older adults, the Health, Aging, and Body Composition (Health ABC) study (n = 2835), and next performed a pooled analysis involving a second older cohort, the Cardiovascular Health Study (n = 1268). Hip BMD was measured by dual-energy X-ray absorptiometry in both cohorts and spine BMD by computed tomography in a subset from Health ABC.Results: In Health ABC, lower BMD at the total hip was associated with higher incident HF in Black women after multivariable adjustment. Similar associations were found for BMD at the femoral neck and spine. In both cohorts, pooled analysis again revealed an association between lower total hip BMD and increased risk of HF in Black women (HR = 1.41 per 0.1-g/cm 2 decrement [95% CI = 1.23-1.62]), and showed the same to be true for White men (HR = 1.12 [1.03-1.21]). There was a decreased risk of HF in Black men Abbreviations: BMD, bone mineral density; CHD, coronary heart disease; CT, computed tomography; DXA, dual-energy X-ray absorptiometry; eGFR, estimated glomerular filtration rate; FEV 1 , forced expiratory volume in 1 s; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HFrEF, heart failure with reduced ejection fraction.

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“…As prevalent public health issues with widespread impact and significant consequences, OP and CVD have consistently garnered considerable attention. While numerous prior epidemiological studies have reported the connection between these conditions, the precise association remains elusive (34)(35)(36)(37)(38)(39)(40)(41)(42)(43). Several factors may contribute to this ambiguity.…”

Section: Discussionmentioning

confidence: 99%

Osteoporosis and coronary heart disease: a bi-directional Mendelian randomization study

Zhang,

Xu,

Liu

et al. 2024

Front. Endocrinol.

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BackgroundOsteoporosis (OP) and cardiovascular disease (CVD) are major global public health issues, especially exacerbated by the challenges of an aging population. As these problems intensify, the associated burden on global health is expected to increase significantly. Despite extensive epidemiological investigations into the potential association between OP and CVD, establishing a clear causal relationship remains elusive.MethodsInstrumental variables were selected from summary statistics of the IEU GWAS database. Five different components of BMD (heel BMD, LS BMD, FA BMD, FN BMD, and TB BMD) were used as OP phenotypes. CHD, MI, and stroke were selected to represent CVD. Multiple analysis methods were used to evaluate the causal relationship between CVD and OP comprehensively. In addition, sensitivity analyses(Cochran’s Q test, MR-Egger intercept test, and “leave one out” analysis) were performed to verify the reliability of the results.ResultsThe MR showed a significant causal relationship between CHD on heel BMD and TB BMD; in the reverse analysis, there was no evidence that OP has a significant causal effect on CVD. The reliability of the results was confirmed through sensitivity analysis.ConclusionThe study results revealed that CHD was causally associated with Heel BMD and TB BMD, while in the reverse MR analysis, the causal relationship between OP and CVD was not supported. This result posits CHD as a potential etiological factor for OP and prompts that routine bone density assessment at traditional sites (forearm, femoral neck, lumbar spine) using DAX may inadequately discern underlying osteoporosis issues in CHD patients. The recommendation is to synergistically incorporate heel ultrasound or DAX for total body bone density examinations, ensuring clinical diagnostics are both precise and reliable. Moreover, these findings provide valuable insights for public health, contributing to the development of pertinent prevention and treatment strategies.

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Bone mineral density and risk of cardiovascular disease in men and women: the HUNT study

Cited by 12 publications

References 53 publications

Bone health, cardiovascular disease, and imaging outcomes in UK Biobank: a causal analysis

Bone health, cardiovascular disease, and imaging outcomes in UK Biobank: a causal analysis

Sex‐ and race‐specific associations of bone mineral density with incident heart failure and its subtypes in older adults

Osteoporosis and coronary heart disease: a bi-directional Mendelian randomization study

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