Prior fragility fracture and risk of incident ischaemic cardiovascular events: results from UK Biobank

Paccou, Julien; D’Angelo, Stefania; Rhodes, Amanda M. L.; Curtis, Elizabeth M; Raisi‐Estabragh, Zahra; Edwards, Mark H.; Walker‐Bone, Karen; Cooper, Cyrus; Petersen, Steffen E.; Harvey, Nicholas C.

doi:10.1007/s00198-018-4426-8

Cited by 13 publications

(12 citation statements)

References 35 publications

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“…The observed association between incident fractures and MACE in CKD is novel in nephrology but is in line with recent evidence in the general population indicating a bidirectional relationship between CVD and poor bone health [ 29–31 , 44 , 45 ]. A recent meta-analysis found consistency across published studies with regard to CVD risk in patients with low (versus high) bone mineral density [pooled HR 1.33 (95% CI 1.27–1.38)] or a history of fractures [HR 1.25 (95% CI 1.05–1.48)] [ 45 ].…”

Section: Discussionsupporting

confidence: 87%

“…Previous studies have focused mostly on in-hospital and short-term mortality [ 8 , 20 , 25–28 ], leaving long-term mortality largely unexplored in CKD. Another plausible consequence of fractures is ischaemic cardiovascular disease (CVD), as recently suggested by general population studies [ 29–32 ]. We are not aware of studies evaluating the association between incident fractures and subsequent cardiovascular events in CKD patients, but we find this hypothesis conceivable given the features of CKD-MBD.…”

Section: Introductionmentioning

confidence: 99%

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Fractures and their sequelae in non-dialysis-dependent chronic kidney disease: the Stockholm CREAtinine Measurement project

Runesson

Trevisan

Iseri

et al. 2019

Nephrology Dialysis Transplantation

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Introduction People undergoing maintenance dialysis are at high risk for fractures, but less is known about fracture incidence and associated outcomes in earlier stages of chronic kidney disease (CKD). Methods We conducted an observational analysis from the Stockholm Creatinine Measurements project, a Swedish health care utilization cohort during 2006–11. We identified all adults with confirmed CKD Stages 3–5 and no documented history of fractures and extracted information on comorbid history, ongoing medication, cardiovascular events and death. We studied incidence rates of fractures (overall and by location), with the estimated glomerular filtration rate (eGFR) as time-dependent exposure. We then studied hazard ratios [HRs and 95% confidence intervals (CIs)] for the events of death and major adverse cardiac events (MACE) using Cox regression with fracture as time-varying exposure. Results We identified 68 764 individuals with confirmed CKD (mean age 79 years, 56% women). During a median follow-up of 2.7 years, 9219 fractures occurred, of which 3105 were hip fractures. A more severe CKD stage was associated with a higher risk of fractures, particularly hip fractures: compared with CKD Stage 3a, the adjusted HR was 1.10 (95% CI 1.02–1.19), 1.32 (1.17–1.49) and 2.47 (1.94–3.15) for CKD Stage 3b, 4 and 5, respectively. Spline curves suggested a linear association with fracture risk with an eGFR <30 mL/min/1.73 m2. Compared with non-fracture periods, incident fracture was associated with a 4-fold increased mortality within 90 days [HR 4.21 (95% CI 3.95–4.49)]. The risk remained elevated beyond 90 days [HR 1.47 (95% CI 1.40–1.54)] and was stronger after hip fractures. Post-fracture MACE risk was also highest in the first 90 days [HR 4.02 (95% CI 3.73–4.33)], particularly after hip fractures, and persisted beyond 90 days [HR 1.20 (95% CI 1.10–1.30)]. Conclusion Our findings highlight the commonness of fractures and the increased risk for subsequent adverse outcomes in CKD patients. These results may inform clinical decisions regarding post-fracture clinical surveillance and fracture prevention strategies.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Fractures and their sequelae in non-dialysis-dependent chronic kidney disease: the Stockholm CREAtinine Measurement project

Runesson

Trevisan

Iseri

et al. 2019

Nephrology Dialysis Transplantation

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“…Other studies confronted these findings, concluding that there is no relationship between smoking and OA [86,87]. Direct mechanical joint injury also can cause acute inflammation, increase the production of IL-1β and IL-6 and chronic post-traumatic OA, low mobility and CVD [88,89].…”

Section: Distinct Risk Factors For Cvd and Oamentioning

confidence: 99%

Cardiovascular Drugs and Osteoarthritis: Effects of Targeting Ion Channels

Vaiciuleviciute

Bironaitė

Uzielienè

et al. 2021

Cells

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Osteoarthritis (OA) and cardiovascular diseases (CVD) share many similar features, including similar risk factors and molecular mechanisms. A great number of cardiovascular drugs act via different ion channels and change ion balance, thus modulating cell metabolism, osmotic responses, turnover of cartilage extracellular matrix and inflammation. These drugs are consumed by patients with CVD for many years; however, information about their effects on the joint tissues has not been fully clarified. Nevertheless, it is becoming increasingly likely that different cardiovascular drugs may have an impact on articular tissues in OA. Here, we discuss the potential effects of direct and indirect ion channel modulating drugs, including inhibitors of voltage gated calcium and sodium channels, hyperpolarization-activated cyclic nucleotide-gated channels, β-adrenoreceptor inhibitors and angiotensin-aldosterone system affecting drugs. The aim of this review was to summarize the information about activities of cardiovascular drugs on cartilage and subchondral bone and to discuss their possible consequences on the progression of OA, focusing on the modulation of ion channels in chondrocytes and other joint cells, pain control and regulation of inflammation. The implication of cardiovascular drug consumption in aetiopathogenesis of OA should be considered when prescribing ion channel modulators, particularly in long-term therapy protocols.

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“…Hip fracture has also been shown to be associated with increased risk of cardiovascular events (2,(13)(14)(15)(16). For example, a Denmark study showed that the one-year adjusted hazard ratio (aHR) of stroke and myocardial infarction (MI) for hip fracture patients was 2.23 and 2.34 respectively, when compared to the general population (16).…”

Section: Introductionmentioning

confidence: 99%

Immediate Risk for Cardiovascular Events in Hip Fracture Patients: A Population-Based Cohort Study

Hsu

Sing

et al. 2021

The Journals of Gerontology: Series A

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Background Emerging evidence showed that bone metabolism and cardiovascular diseases (CVD) are closely related. We previously observed a potential immediate risk of cardiovascular mortality after hip fracture. However, whether there is an immediate risk of cardiovascular events after hip fracture is unclear. The aim of this study was to evaluate the risk for major adverse cardiovascular events (MACEs) between patients having experienced falls with and without hip fracture. Methods This retrospective population-based cohort study used data from a centralized electronic health record database managed by Hong Kong Hospital Authority. Patients having experienced falls with and without hip fracture were matched by propensity score (PS) at a 1:1 ratio. Adjusted associations between hip fracture and risk of MACEs were evaluated using competing risk regression after accounting for competing risk of death. Results Competing risk regression showed that hip fracture was associated with increased one-year risk of MACEs (hazard ratio [HR], 1.27; 95% CI, 1.21 to 1.33; p<0.001), with a 1-year cumulative incidence difference of 2.40% (1.94% to 2.87%). The HR was the highest in the first 90-day after hip fracture (HR of 1.32), and such an estimate was continuously reduced in 180-day, 270-day, and 1-year after hip fracture. Conclusions Hip fracture was associated with increased immediate risk of MACEs. This study suggested that a prompt evaluation of MACE among older adults aged 65 years and older who are diagnosed with hip fracture irrespectively of cardiovascular risk factors may be important, as early management may reduce subsequent risk of MACE.

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Prior fragility fracture and risk of incident ischaemic cardiovascular events: results from UK Biobank

Cited by 13 publications

References 35 publications

Fractures and their sequelae in non-dialysis-dependent chronic kidney disease: the Stockholm CREAtinine Measurement project

Fractures and their sequelae in non-dialysis-dependent chronic kidney disease: the Stockholm CREAtinine Measurement project

Cardiovascular Drugs and Osteoarthritis: Effects of Targeting Ion Channels

Immediate Risk for Cardiovascular Events in Hip Fracture Patients: A Population-Based Cohort Study

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