Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Nuffield Orthopaedic Centre, University of Oxford, Oxford, UK.
MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
J Bone Miner Res. 2022 Oct;37(10):1986-1996. doi: 10.1002/jbmr.4648. Epub 2022 Sep 8.
The objective of this work was to estimate the incidence rate of cardiovascular disease (CVD) events (myocardial infarction, stroke, or CVD death) at 1 year among three cohorts of patients at high risk of fracture (osteoporosis, previous fracture, and anti-osteoporosis medication) and to identify the key risk factors of CVD events in these three cohorts. To do so, this prospective cohort study used data from the Clinical Practice Research Datalink, a primary care database from United Kingdom. Major adverse cardiovascular events (MACE, a composite outcome for the occurrence of either myocardial infarction [MI], stroke, or CVD death) were identified in patients aged 50 years or older at high or imminent fracture risk identified in three different cohorts (not mutually exclusive): recently diagnosed with osteoporosis (OST, n = 65,295), incident fragility fracture (IFX, n = 67,065), and starting oral bisphosphonates (OBP, n = 145,959). About 1.90%, 4.39%, and 2.38% of the participants in OST, IFX, and OBP cohorts, respectively, experienced MACE events. IFX was the cohort with the higher risk: MACE incidence rates (cases/1000 person-years) were 19.63 (18.54-20.73) in OST, 52.64 (50.7-54.5) in IFX, and 26.26 (25.41-27.12) in OBP cohorts. Risk of MACE events at 1 year was predicted in the three cohorts. Models using a set of general, CVD, and fracture candidates selected by lasso regression had a good discrimination (≥70%) and internal validity and generally outperformed the models using only the CVD risk factors of general population listed in QRISK tool. Main risk factors common in all MACE models were sex, age, smoking, alcohol, atrial fibrillation, antihypertensive medication, prior MI/stroke, established CVD, glomerular filtration rate, systolic blood pressure, cholesterol levels, and number of concomitant medicines. Identified key risk factors highlight the differences of patients at high risk of fracture versus general population. Proposed models could improve prediction of CVD events in patients with osteoporosis in primary care settings. © 2022 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
本研究旨在评估三个高骨折风险队列（骨质疏松症、既往骨折和抗骨质疏松症药物）的患者在 1 年内发生心血管疾病（CVD）事件（心肌梗死、中风或 CVD 死亡）的发生率，并确定这些队列中 CVD 事件的关键风险因素。为此，这项前瞻性队列研究使用了来自英国初级保健数据库的临床实践研究 Datalink 的数据。在三个不同的队列（非互斥）中，识别出年龄在 50 岁或以上且具有高或即将发生骨折风险的患者中发生的主要不良心血管事件（MACE，心肌梗死 [MI]、中风或 CVD 死亡的复合结局）：最近诊断为骨质疏松症（OST，n=65295）、脆性骨折（IFX，n=67065）和开始口服双膦酸盐（OBP，n=145959）。OST、IFX 和 OBP 队列的参与者中，分别有 1.90%、4.39%和 2.38%发生了 MACE 事件。IFX 队列的风险更高：MACE 发生率（每 1000 人年的病例数）分别为 OST 队列的 19.63（18.54-20.73）、IFX 队列的 52.64（50.7-54.5）和 OBP 队列的 26.26（25.41-27.12）。在三个队列中均预测到了 MACE 事件的风险。使用套索回归选择的一般、CVD 和骨折候选物的一组建立的模型具有良好的区分度（≥70%）和内部有效性，并且通常优于仅使用 QRISK 工具中列出的一般人群 CVD 危险因素的模型。所有 MACE 模型中的主要危险因素均为性别、年龄、吸烟、饮酒、心房颤动、抗高血压药物、既往 MI/中风、已确立的 CVD、肾小球滤过率、收缩压、胆固醇水平和同时服用的药物数量。确定的关键风险因素突出了高骨折风险患者与一般人群的差异。所提出的模型可以提高初级保健环境中骨质疏松症患者 CVD 事件的预测能力。
