Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Research Institute, California Pacific Medical Center, San Francisco, California, USA.
J Am Geriatr Soc. 2023 Mar;71(3):742-755. doi: 10.1111/jgs.18121. Epub 2022 Nov 5.
Previous studies have suggested an association between bone mineral density (BMD) and heart failure (HF) risk that may be race-dependent.
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.
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 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 (HR 0.80 [0.70-0.91]), but no relationship in White women. The associations were numerically stronger with HFpEF for Black women and White men, and with HFrEF for Black men. Findings were similar for femoral neck BMD. Sensitivity analyses delaying HF follow-up by 2 years eliminated the association in Black men.
Lower BMD was associated with higher risk of HF and especially HFpEF in older Black women and White men, highlighting the need for additional investigation into underlying mechanisms.
先前的研究表明，骨密度（BMD）与心力衰竭（HF）风险之间存在关联，这种关联可能依赖于种族。
我们评估了骨密度与健康、老龄化和身体成分研究（Health ABC 研究）中年龄较大的队列中 HF 事件发生率之间的关系（n=2835），并对第二个老年队列心血管健康研究（n=1268）进行了汇总分析。两个队列均通过双能 X 射线吸收法测量髋部 BMD，Health ABC 中的一部分参与者通过计算机断层扫描测量脊柱 BMD。
在 Health ABC 中，经多变量调整后，黑人女性全髋 BMD 较低与 HF 事件发生率升高相关。在股骨颈和脊柱 BMD 方面也发现了类似的关联。在两个队列的汇总分析中，再次发现黑人女性全髋 BMD 较低与 HF 风险增加相关（每降低 0.1g/cm，HR=1.41 [95%CI=1.23-1.62]），白人男性也存在同样的情况（HR=1.12 [1.03-1.21]）。黑人男性 HF 风险降低（HR 0.80 [0.70-0.91]），但白人女性无此关联。黑人女性和白人男性 HFpEF 的相关性更强，黑人男性 HFrEF 的相关性更强。这些关联在股骨颈 BMD 方面也类似。敏感性分析将 HF 随访延迟 2 年，消除了黑人男性的关联。
较低的 BMD 与 HF 风险增加相关，尤其是与年龄较大的黑人女性和白人男性的 HFpEF 相关，这突显了需要进一步研究潜在机制。
