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

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

Summary: In the large UK Biobank population-based cohort, we found that amongst men, but not women, prior fragility fracture was associated with increased risk of admission with ischaemic heart disease. Introduction: We aimed to investigate the relationship between prior fracture and risk of incident ischaemic cardiovascular events in a UK population-based cohort. Methods: UK Biobank is a large prospective cohort comprising 502,637 men and women aged 40–69 years, with detailed baseline assessment. History of fracture was self-reported, and details of hospital admissions for ischaemic heart disease (IHD) (ICD-10:I20-I25) were obtained through linkage to UK Hospital Episode Statistics. Cox proportional hazards models were used to investigate the prospective relationships between prior fracture and hospital admission for men and women, controlling for age, BMI, smoking, alcohol, educational level, physical activity, systolic blood pressure, calcium and vitamin D use, ankle spacing-width, heel BUA and HRT use (women). Results: Amongst men, a fragility fracture (hip, spine, wrist or arm fracture resulting from a simple fall) within the previous 5 years was associated with a 35% increased risk of IHD admission (fully adjusted HR 1.35; 95%CI 1.00, 1.82; p = 0.047), with the relationship predominantly driven by wrist fractures. Associations with hospitalisation for angina in men were similar in age-adjusted models [HR1.54; 95%CI: 1.03, 2.30), p = 0.037], but did not remain statistical significant after full adjustment [HR 1.64; 95%CI: 0.88, 3.07); p = 0.121]. HRs for admission with angina were lower in women, and neither age- nor fully adjusted relationships attained statistical significance. Conclusions: Prior fragility fracture is an independent risk factor for incident ischaemic cardiovascular events in men. Further work may clarify whether this association is causal or represents shared risk factors, but these findings are likely to be of value in risk assessment of both osteoporosis and cardiovascular disease.

0937-941X
1-8
Paccou, Julien
1b444e18-74b1-4d69-be7f-49295ae64ffb
D'angelo, Stefania
13375ecd-1117-4b6e-99c0-32239f52eed6
Rhodes, Amanda
c6582f43-4f26-4694-b6ed-dd30de1fecbc
Curtis, Elizabeth
12aba0c3-1e9e-49ef-a7e9-3247e649cdd6
Raisi-Estabragh, Zahra
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Edwards, Mark
0b95b131-86cc-4ee7-b5fd-4694d9acbf0d
Walker-Bone, Karen
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Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Petersen, Steffen E.
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Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145
Paccou, Julien
1b444e18-74b1-4d69-be7f-49295ae64ffb
D'angelo, Stefania
13375ecd-1117-4b6e-99c0-32239f52eed6
Rhodes, Amanda
c6582f43-4f26-4694-b6ed-dd30de1fecbc
Curtis, Elizabeth
12aba0c3-1e9e-49ef-a7e9-3247e649cdd6
Raisi-Estabragh, Zahra
43c85c5e-4574-476b-80d6-8fb1cdb3df0a
Edwards, Mark
0b95b131-86cc-4ee7-b5fd-4694d9acbf0d
Walker-Bone, Karen
ad7d1336-ed2c-4f39-ade5-da84eb412109
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Petersen, Steffen E.
04f2ce88-790d-48dc-baac-cbe0946dd928
Harvey, Nicholas
ce487fb4-d360-4aac-9d17-9466d6cba145

Paccou, Julien, D'angelo, Stefania, Rhodes, Amanda, Curtis, Elizabeth, Raisi-Estabragh, Zahra, Edwards, Mark, Walker-Bone, Karen, Cooper, Cyrus, Petersen, Steffen E. and Harvey, Nicholas (2018) Prior fragility fracture and risk of incident ischaemic cardiovascular events: results from UK Biobank. Osteoporosis International, 1-8. (doi:10.1007/s00198-018-4426-8).

Record type: Article

Abstract

Summary: In the large UK Biobank population-based cohort, we found that amongst men, but not women, prior fragility fracture was associated with increased risk of admission with ischaemic heart disease. Introduction: We aimed to investigate the relationship between prior fracture and risk of incident ischaemic cardiovascular events in a UK population-based cohort. Methods: UK Biobank is a large prospective cohort comprising 502,637 men and women aged 40–69 years, with detailed baseline assessment. History of fracture was self-reported, and details of hospital admissions for ischaemic heart disease (IHD) (ICD-10:I20-I25) were obtained through linkage to UK Hospital Episode Statistics. Cox proportional hazards models were used to investigate the prospective relationships between prior fracture and hospital admission for men and women, controlling for age, BMI, smoking, alcohol, educational level, physical activity, systolic blood pressure, calcium and vitamin D use, ankle spacing-width, heel BUA and HRT use (women). Results: Amongst men, a fragility fracture (hip, spine, wrist or arm fracture resulting from a simple fall) within the previous 5 years was associated with a 35% increased risk of IHD admission (fully adjusted HR 1.35; 95%CI 1.00, 1.82; p = 0.047), with the relationship predominantly driven by wrist fractures. Associations with hospitalisation for angina in men were similar in age-adjusted models [HR1.54; 95%CI: 1.03, 2.30), p = 0.037], but did not remain statistical significant after full adjustment [HR 1.64; 95%CI: 0.88, 3.07); p = 0.121]. HRs for admission with angina were lower in women, and neither age- nor fully adjusted relationships attained statistical significance. Conclusions: Prior fragility fracture is an independent risk factor for incident ischaemic cardiovascular events in men. Further work may clarify whether this association is causal or represents shared risk factors, but these findings are likely to be of value in risk assessment of both osteoporosis and cardiovascular disease.

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jp fracture CVD UKB 19_01_2018 R2 clean - Accepted Manuscript
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ONLINE SUPPLEMENTARY MATERIAL UKB fracture CVD 20_12_2017
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Accepted/In Press date: 6 February 2018
e-pub ahead of print date: 26 February 2018

Identifiers

Local EPrints ID: 417805
URI: https://eprints.soton.ac.uk/id/eprint/417805
ISSN: 0937-941X
PURE UUID: 24a526dc-6d8a-470a-a3dd-e08c827a3ed3
ORCID for Stefania D'angelo: ORCID iD orcid.org/0000-0002-7267-1837
ORCID for Elizabeth Curtis: ORCID iD orcid.org/0000-0002-5147-0550
ORCID for Karen Walker-Bone: ORCID iD orcid.org/0000-0002-5992-1459
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709
ORCID for Nicholas Harvey: ORCID iD orcid.org/0000-0002-8194-2512

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Date deposited: 14 Feb 2018 17:30
Last modified: 22 Oct 2019 04:31

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Contributors

Author: Julien Paccou
Author: Stefania D'angelo ORCID iD
Author: Amanda Rhodes
Author: Zahra Raisi-Estabragh
Author: Mark Edwards
Author: Cyrus Cooper ORCID iD
Author: Steffen E. Petersen
Author: Nicholas Harvey ORCID iD

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