心血管自主神经系统功能与髋部骨折风险：心血管健康研究。
Cardiovascular autonomic nervous system function and hip fracture risk: the Cardiovascular Health Study.
机构信息
Division of Cardiology, Washington University School of Medicine, St. Louis, MO, USA.
Department of Biostatistics, University of Washington School of Public Health, Seattle, WA, USA.
出版信息
Arch Osteoporos. 2021 Oct 31;16(1):163. doi: 10.1007/s11657-021-01028-y.
UNLABELLED
Among 1299 older adults with 24-h Holter monitoring data at baseline, followed for approximately 15 years, 190 incident hip fractures occurred. Increased heart rate variability was independently associated with reduced risk of hip fracture among female participants.
PURPOSE
Autonomic nervous system function modulates bone remodeling in rodent osteoporosis models. We tested whether cardiovascular autonomic function is associated with hip fracture risk in humans.
METHODS
Participants were 1299 subjects from the Cardiovascular Health Study (mean age 72.8 years). Eight heart rate variability (HRV) measures (time and frequency domains, detrended fluctuation analysis variables, and heart rate turbulence) were derived from 24-h Holter monitor scans in sinus rhythm. Median follow-up for incident hip fracture was 14.7 years [IQR 9.1, 20.2]. Cox proportional hazards models were used to calculate hazard ratios (95% confidence intervals, CI).
RESULTS
There were 144 hip fractures among 714 women (1.31 [1.06, 1.61] per 100-person years) and 46 among 585 men (0.62 [0.43, 0.90] per 100 person-years). From among HRV variables examined, a one standard deviation (SD) higher variation between normal heart beats over 24 h (the SD of NN intervals [SDNN]) was associated with a multivariable-adjusted lower hip fracture risk (HR [Formula: see text] 0.80; 95% CI 0.65-0.99; p = 0.04) in women. The adjusted association between very low frequency power, and hip fracture was borderline statistically significant in women (HR [Formula: see text] 0.82; 95% CI, 0.66-1.00; p = 0.06). When the 8 HRV variables were considered conjointly and adjusted for each other's association with hip fracture risk, a 1 SD higher SDNN value was significantly associated with reduced hip fracture risk in women (HR 0.74; 95% CI, 0.50-0.99; p = 0.05). No HRV variables were associated with hip fracture in men.
CONCLUSIONS
In older women, increased heart rate variation is associated with hip fracture risk.
目的：自主神经系统功能调节啮齿动物骨质疏松模型中的骨重塑。我们测试了心血管自主神经功能是否与人类髋部骨折风险相关。
方法：参与者是来自心血管健康研究（平均年龄 72.8 岁）的 1299 名受试者。从窦性节律 24 小时 Holter 监测扫描中得出了 8 个心率变异性（HRV）测量值（时域和频域、去趋势波动分析变量和心率震荡）。新发髋部骨折的中位随访时间为 14.7 年[IQR 9.1，20.2]。使用 Cox 比例风险模型计算危险比（95%置信区间，CI）。
结果：在 714 名女性中，有 144 例髋部骨折（每 100 人年 1.31 [1.06，1.61]），585 名男性中有 46 例髋部骨折（每 100 人年 0.62 [0.43，0.90]）。在所检查的 HRV 变量中，24 小时内正常心跳之间的变异（NN 间隔的标准差 [SDNN]）增加一个标准差与女性多变量调整后的髋部骨折风险降低相关（HR [公式：见文本]0.80；95%CI 0.65-0.99；p=0.04）。在女性中，非常低频功率与髋部骨折之间的关联具有统计学意义上的边界显著性（HR [公式：见文本]0.82；95%CI，0.66-1.00；p=0.06）。当考虑到 8 个 HRV 变量并相互调整与髋部骨折风险的关联时，SDNN 值增加一个标准差与女性髋部骨折风险降低显著相关（HR 0.74；95%CI，0.50-0.99；p=0.05）。在男性中，没有 HRV 变量与髋部骨折相关。
结论：在老年女性中，心率变化增加与髋部骨折风险相关。
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