Poor bone quality is associated with greater arterial stiffness: insights from the UK biobank
Poor bone quality is associated with greater arterial stiffness: insights from the UK biobank
Osteoporosis and ischemic heart disease (IHD) represent important public health problems. Existing research suggests an association between the two conditions beyond that attributable to shared risk factors, with a potentially causal relationship. In this study, we tested the association of bone speed of sound (SOS) from quantitative heel ultrasound with (i) measures of arterial compliance from cardiovascular magnetic resonance (aortic distensibility [AD]); (ii) finger photoplethysmography (arterial stiffness index [ASI]); and (iii) incident myocardial infarction and IHD mortality in the UK Biobank cohort. We considered the potential mediating effect of a range of blood biomarkers and cardiometabolic morbidities and evaluated differential relationships by sex, menopause status, smoking, diabetes, and obesity. Furthermore, we considered whether associations with arterial compliance explained association of SOS with ischemic cardiovascular outcomes. Higher SOS was associated with lower arterial compliance by both ASI and AD for both men and women. The relationship was most consistent with ASI, likely relating to larger sample size available for this variable (n = 159,542 versus n = 18,229). There was no clear evidence of differential relationship by menopause, smoking, diabetes, or body mass index (BMI). Blood biomarkers appeared important in mediating the association for both men and women, but with different directions of effect and did not fully explain the observed effects. In fully adjusted models, higher SOS was associated with significantly lower IHD mortality in men, but less robustly in women. The association of SOS with ASI did not explain this observation. In conclusion, our findings support a positive association between bone and vascular health with consistent patterns of association in men and women. The underlying mechanisms are complex and appear to vary by sex.
ARTERIAL STIFFNESS, CARDIOVASCULAR DISEASE, EPIDEMIOLOGY, ISCHEMIC HEART DISEASE, OSTEOPOROSIS
90-99
Raisi-Estabragh, Zahra
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Biasiolli, Luca
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Cooper, Jackie
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Aung, Nay
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Fung, Kenneth
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Paiva, José M.
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Sanghvi, Mihir M.
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Thomson, Ross J.
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Curtis, Elizabeth
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Paccou, Julien
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Rayner, Jennifer J.
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Werys, Konrad
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Puchta, Henrike
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Thomas, Katharine E.
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Lee, Aaron M.
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Piechnik, Stefan K.
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Neubauer, Stefan
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Munroe, Patricia B.
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Cooper, Cyrus
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Petersen, Steffen E.
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Harvey, Nicholas C
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19 January 2021
Raisi-Estabragh, Zahra
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Biasiolli, Luca
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Cooper, Jackie
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Aung, Nay
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Fung, Kenneth
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Paiva, José M.
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Sanghvi, Mihir M.
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Thomson, Ross J.
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Curtis, Elizabeth
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Paccou, Julien
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Rayner, Jennifer J.
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Werys, Konrad
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Puchta, Henrike
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Thomas, Katharine E.
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Lee, Aaron M.
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Piechnik, Stefan K.
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Neubauer, Stefan
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Munroe, Patricia B.
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Cooper, Cyrus
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Petersen, Steffen E.
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Harvey, Nicholas C
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Raisi-Estabragh, Zahra, Biasiolli, Luca, Cooper, Jackie, Aung, Nay, Fung, Kenneth, Paiva, José M., Sanghvi, Mihir M., Thomson, Ross J., Curtis, Elizabeth, Paccou, Julien, Rayner, Jennifer J., Werys, Konrad, Puchta, Henrike, Thomas, Katharine E., Lee, Aaron M., Piechnik, Stefan K., Neubauer, Stefan, Munroe, Patricia B., Cooper, Cyrus, Petersen, Steffen E. and Harvey, Nicholas C
(2021)
Poor bone quality is associated with greater arterial stiffness: insights from the UK biobank.
Journal of Bone and Mineral Research, 36 (1), .
(doi:10.1002/jbmr.4164).
Abstract
Osteoporosis and ischemic heart disease (IHD) represent important public health problems. Existing research suggests an association between the two conditions beyond that attributable to shared risk factors, with a potentially causal relationship. In this study, we tested the association of bone speed of sound (SOS) from quantitative heel ultrasound with (i) measures of arterial compliance from cardiovascular magnetic resonance (aortic distensibility [AD]); (ii) finger photoplethysmography (arterial stiffness index [ASI]); and (iii) incident myocardial infarction and IHD mortality in the UK Biobank cohort. We considered the potential mediating effect of a range of blood biomarkers and cardiometabolic morbidities and evaluated differential relationships by sex, menopause status, smoking, diabetes, and obesity. Furthermore, we considered whether associations with arterial compliance explained association of SOS with ischemic cardiovascular outcomes. Higher SOS was associated with lower arterial compliance by both ASI and AD for both men and women. The relationship was most consistent with ASI, likely relating to larger sample size available for this variable (n = 159,542 versus n = 18,229). There was no clear evidence of differential relationship by menopause, smoking, diabetes, or body mass index (BMI). Blood biomarkers appeared important in mediating the association for both men and women, but with different directions of effect and did not fully explain the observed effects. In fully adjusted models, higher SOS was associated with significantly lower IHD mortality in men, but less robustly in women. The association of SOS with ASI did not explain this observation. In conclusion, our findings support a positive association between bone and vascular health with consistent patterns of association in men and women. The underlying mechanisms are complex and appear to vary by sex.
Text
manuscriptrevised_jbmr2
- Accepted Manuscript
Text
jbmr.4164 (1)
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More information
Accepted/In Press date: 5 August 2020
e-pub ahead of print date: 22 September 2020
Published date: 19 January 2021
Additional Information:
Funding Information:
This work was supported by UK Medical Research Council (4050502589 [MRC LEU]); British Heart Foundation; Arthritis Research UK; Royal Osteoporosis Society Osteoporosis and Bone Research Academy; International Osteoporosis Foundation; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust; National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford; and National Institute for Health Research Cardiovascular Biomedical Research Unit at Barts. EMC is supported by the Wellcome Trust and National Institute for Health Research. This research has been conducted using the UK Biobank Resource (access reference 2964). NA and MMS recognize the National Institute for Health Research (NIHR) Integrated Academic Training programme, which supports their Academic Clinical Lectureship and Academic Clinical Fellowship posts, respectively. Authors' roles: All authors contributed to preparation and final approval of the manuscript. ZRE, NCH, EMC, JP, and SEP led the initial project and drafting; ZRE and JC undertook statistical analysis; LB performed aortic distensibility analysis, image quality control, and supervised the validation of automated results; NA, KF, EL, EH, JMP, MMS, and RJT performed manual validation of aortic distensibility results; NCH/SEP oversaw the project and are guarantors. Author contributions: Zahra Raisi-Estabragh: Conceptualization; formal analysis; investigation; methodology; visualization; writing-original draft; writing-review and editing. Luca Biasiolli: Data curation; writing-review and editing. Jackie Cooper: Formal analysis; investigation; methodology. Nay Aung: Data curation; writing-review and editing. Kenneth Fung: Data curation; writing-review and editing. Jose Paiva: Data curation; writing-review and editing. Mihir Sanghvi: Data curation; writing-review and editing. Ross Thomson: Data curation; writing-review and editing. Beth Curtis: Conceptualization; writing-review and editing. Julien Paccou: Writing-review and editing. Jennifer Rayner: Data curation; writing-review and editing. Konrad Werys: Data curation; writing-review and editing. Henrike Puchta: Data curation; writing-review and editing. Katharine E Tomas: Data curation; writing-review and editing. Aaron Lee: Data curation; writing-review and editing. Stefan Piechnik: Data curation; writing-review and editing. Stefan Neubauer: Data curation; writing-review and editing. Patricia Munroe: Supervision; writing-review and editing. Cyrus Cooper: Writing-review and editing. Steffen Petersen: Conceptualization; supervision; writing-original draft; writing-review and editing. Nicholas Harvey: Conceptualization; supervision; writing-original draft; writing-review and editing.
Funding Information:
ZRE is supported by British Heart Foundation Clinical Research Training Fellowship no. FS/17/81/33318. SEP acknowledges support from the National Institute for Health Research (NIHR) Cardiovascular Biomedical Research Centre at Barts and he received funding from the European Union's Horizon 2020 research and innovation programme under grant agreement No 825903. SEP, SN, and SKP acknowledge the British Heart Foundation for funding the manual analysis to create a cardiovascular magnetic resonance imaging reference standard for the UK Biobank imaging resource in 5000 CMR scans ( www.bhf.org.uk ; PG/14/89/31194). LB acknowledges the support of the British Heart Foundation (PG/15/74/31747). NA is supported by a Wellcome Trust Research Training Fellowship ( wellcome.ac.uk ; 203553/Z/Z). KF is supported by the Medical College of Saint Bartholomew's Hospital Trust, an independent registered charity that promotes and advances medical and dental education and research at Barts and The London School of Medicine and Dentistry. SEP and AML acknowledge support from the NIHR Biomedical Research Centre at Barts and from the “SmartHeart” EPSRC programme grant ( www.nihr.ac.uk ; EP/P001009/1). SN and SKP are supported by the Oxford NIHR Biomedical Research Centre and the Oxford British Heart Foundation Centre of Research Excellence. SEP acts as a paid consultant to Circle Cardiovascular Imaging Inc., Calgary, ON, Canada, and Servier. NCH has received consultancy, lecture fees, and honoraria from Alliance for Better Bone Health, Amgen, MSD, Eli Lilly, Servier, Shire, Radius Health, UCB, Consilient Healthcare, Kyowa Kirin, and Internis Pharma. CC has received consultancy, lecture fees, and honoraria from Amgen, GlaxoSmithKline, Alliance for Better Bone Health, Merck Sharp & Dohme, Eli Lilly, Pfizer, Novartis, Servier, Medtronic, and Roche. EC reports honoraria/travel support from Eli Lilly, UCB, Pfizer, and Amgen outside the submitted work.
Funding Information:
This work was supported by UK Medical Research Council (4050502589 [MRC LEU]); British Heart Foundation; Arthritis Research UK; Royal Osteoporosis Society Osteoporosis and Bone Research Academy; International Osteoporosis Foundation; National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust; National Institute for Health Research Oxford Biomedical Research Centre, University of Oxford; and National Institute for Health Research Cardiovascular Biomedical Research Unit at Barts. EMC is supported by the Wellcome Trust and National Institute for Health Research. This research has been conducted using the UK Biobank Resource (access reference 2964). NA and MMS recognize the National Institute for Health Research (NIHR) Integrated Academic Training programme, which supports their Academic Clinical Lectureship and Academic Clinical Fellowship posts, respectively.
Publisher Copyright:
© 2020 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
Keywords:
ARTERIAL STIFFNESS, CARDIOVASCULAR DISEASE, EPIDEMIOLOGY, ISCHEMIC HEART DISEASE, OSTEOPOROSIS
Identifiers
Local EPrints ID: 444088
URI: http://eprints.soton.ac.uk/id/eprint/444088
ISSN: 0884-0431
PURE UUID: 9da0f397-d173-459f-9b1f-8e09c34d83b2
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Date deposited: 24 Sep 2020 16:44
Last modified: 18 Mar 2024 03:38
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Contributors
Author:
Zahra Raisi-Estabragh
Author:
Luca Biasiolli
Author:
Jackie Cooper
Author:
Nay Aung
Author:
Kenneth Fung
Author:
José M. Paiva
Author:
Mihir M. Sanghvi
Author:
Ross J. Thomson
Author:
Julien Paccou
Author:
Jennifer J. Rayner
Author:
Konrad Werys
Author:
Henrike Puchta
Author:
Katharine E. Thomas
Author:
Aaron M. Lee
Author:
Stefan K. Piechnik
Author:
Stefan Neubauer
Author:
Patricia B. Munroe
Author:
Steffen E. Petersen
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