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Hip fracture may increase MI, stroke risk
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Adults who experience a hip fracture may have increased risks for myocardial infarction and stroke, suggesting the importance of targeting multimorbidity, including prevention and adequate treatment, to improve future prognosis, according to researchers.
Alma B. Pedersen, MD, PhD, DMSc, of the department of clinical epidemiology at Aarhus University Hospital in Denmark, and colleagues evaluated 1995 to 2015 data from the Danish National Patient Registry on adults aged 55 years or older with a history of hip fracture (n = 110,563) and matched controls (n = 552,774) to determine the risks for MI and stroke.
Researchers calculated a Charlson Comorbidity Index score for each participant, and scores were categorized as follows: no previous record of diseases, and medium, severe, and very severe comorbidity levels. The index date of the study was defined as the date of hip fracture diagnosis, and follow-up was conducted until occurrence of MI or stroke, emigration, death or December 2015.
Sixty percent of the hip fracture group and 73% of the control group had none of the comorbidities included in the Charlson Comorbidity Index.
Incidence of MI was higher in the fracture group (1.15%) compared with the control group (0.09%) in the 30 days after the index date (adjusted HR = 12.97; 95% CI, 11.56-14.55). In the first 30 days, previous MI was the most common comorbidity driving the interaction (76%), followed by congestive heart failure (48%), peripheral vascular disease (46%), moderate to severe renal disease (35%), diabetes with organ damage (34%), diabetes type 1 and 2 without organ damage (31%), and cerebrovascular disease (28%). Incidence of MI was slightly higher in the control group (0.9%) compared with the fracture group (0.89%) during the 31 to 365 days after the index date (aHR = 1.05; 95% CI, 0.97-1.14).
Incidence of stroke was higher in the fracture group (2.16%) compared with the control group (0.21%) in the 30 days after the index date (aHR = 9.42; 95% CI, 8.71-10.19). In the first 30 days, previous stroke was the most common comorbidity driving the interaction (76%), followed by cerebrovascular disease (72%), hemiplegia (43%), diabetes with organ damage (37%), diabetes type 1 and 2 without organ damage (32%), peripheral vascular disease (29%) and moderate to severe renal disease (12%). Incidence of stroke remained higher in the fracture group (2.39%) compared with the control group (1.93%) in the 31 to 365 days after the index date (aHR = 1.29; 95% CI, 1.22-1.359). The risk for stroke remained increased in the fracture group up to 10 years after the diagnosis (HR = 1.11; 95% CI, 1.05-1.18).
“There is accumulating evidence that osteoporosis and cardiovascular disease share common pathophysiological and genetic risk factors,” the researchers wrote. “Severe pathophysiological mechanisms, including inflammatory cytokines, endogenous sex hormones, oxidized lipids and dyslipidemia, vitamin D and vitamin D deficiency, low calcium intake, oxidative stress and diabetes also are involved in the progression of the two conditions.” – by Amber Cox
Disclosures: The authors report no relevant financial disclosures.
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