Reduced bone mineral density may predict HF risk

Reduced bone mineral density is associated with increased risk for HF in seemingly healthy patients, according to results from the EPIC-Norfolk study.

In the prospective study, researchers analyzed the relationship between bone mineral density (BMD) and incident HF events in 13,666 evidently healthy individuals aged 42 to 82 years (mean age, 61.5 years) who were enrolled in the EPIC study in Norfolk, United Kingdom. BMD was expressed as broadband ultrasound attenuation (BUA) via quantitative ultrasound of the heel. The patients were followed for a mean of 9.3 years and had a mean BUA of 80.2 ± 19.1 db/MHz.

During the study period, 380 incident cases of HF occurred, with the risk for HF decreasing in proportion to increasing bone density. Compared with the lowest BUA quartile, risk for HF was lower in all other quartiles, with HRs of 0.4 (95% CI, 0.27-0.59), 0.54 (95% CI, 0.37-0.79) and 0.46 (95% CI, 0.32-0.68) for subsequent quartiles after adjustment for confounders, including age, sex, tobacco and alcohol use, physical activity, socioeconomic status, education, systolic BP, diabetes, cholesterol and BMI (P for trend=.002).

The researchers noted that, for every increase of BMD by one standard deviation, risk for HF decreased by 23% (HR=0.77; 95% CI, 0.66-0.89). The association between HF risk and BMD was more pronounced for cases of HF without preceding MI (HR=0.75; 95% CI, 0.63-0.89) rather than with preceding MI (HR=0.82; 95% CI, 0.62-1.09).

Secondary analyses that excluded patients with incident HF during the first 2 years of follow-up; those with prevalent osteoporosis or a history of bone fractures; or users of diuretics, steroids/NSAIDs or calcium or vitamin D supplements yielded similar results. Assessment incorporating ischemic heart disease as a time-dependent variable, as well as additional adjustment for dietary intake of vitamin D, also did not significantly alter results.

“To our knowledge, this is the first study to establish an independent association between bone mineral density and the subsequent development of HF,” the researchers wrote. “… Our findings give support for cardiac assessment in people with reduced bone mineral density and warrant further exploration of underlying biological mechanisms.”

Kenneth W. Lyles, MD, and Cathleen S. Colon-Emeric, MD, MHSc, of Duke University and VA Medical Centers in Durham, N.C., wrote that they are “intrigued” by the promise suggested by these results of simple interventions that can reduce the burden of both HF and osteoporosis.

“The next step after such a provocative finding will be to replicate the association in another large database,” they wrote. ”Fortunately, with the wealth of existing well-defined cohorts, such studies should be relatively easy to accomplish. With confirmation of the observations made by Pfister et al, a new area of CV/bone biology research will begin.”

For more information:

Lyles KW. J Am Coll Cardiol HF. 2014;2:390-391.

Pfister R. J Am Coll Cardiol HF. 2014;2:380-389.

Disclosure: The researchers report no relevant financial disclosures. Lyles and Colon-Emeric are founders and equity owners of BisCardia Inc.