Study finds women with mid-life height loss may face greater cardiovascular, death risks

Women in northern Europe who lost height during middle age faced a greater risk of early death, primarily due to heart disease or stroke, according to an observational study published in BMJ Open.

Regular physical activity may hold height loss at bay as well as reduce cardiovascular disease risk, author Sofia Klingberg, PhD, of Sahlgrenska Academy at the University of Gothenburg in Sweden, and colleagues said in the study.

Once people reach their 50s, they begin losing their height, and this process accelerates as people reach their 70s, the researchers said. Vertebral disc shrinkage, spinal compression fractures and changes in posture usually cause this loss.

Even though women tend to lose more height than men, height loss in women has not been well studied, said the researchers, who then wanted to discover if mid-life height loss might predict death from all causes, specifically death from heart disease and stroke.

The study examined 2,406 women born between 1908 and 1952, including 1,147 Swedish women as part of the Swedish Prospective Population Study of Women in Gothenburg (PPSWG) and 1,259 Danish women as part of the Monitoring Trends and Determinants of Cardiovascular Disease (MONICA) study.

Each of these studies began by measuring height in the morning without shoes when the women were aged 30 to 60 years, with two-thirds of the participants aged 38 to 52 years. Height measurements were taken again between 10 to 13 years later.

The PPSWG and MONICA studies also documented the date and cause of death for 17 to 19 years after the second height measurement. Potentially influential factors such as weight, smoking, leisure time physical activity, alcohol intake and education were recorded as well.

The participants lost an average of 0.8 cm between the first and second height measurements, with a range of 0 to 14 cm.

During the 19-year total monitoring period, 625 of the women died from all causes. But during the 17-year period, cardiovascular disease was the primary cause of death in 157 women, including 37 cases of stroke. Also, 262 cases were due to other causes.

After adjusting for potentially influential factors, each centimeter of height loss was associated with 14% greater odds of death from any cause among the Swedish women and 21% among the Danish women.

The study further associated a short stature and high leisure time physical activity at the beginning of the studies with less height loss, independent of age.

Major height loss defined as more than 2 cm was associated with 74% greater odds of death for Swedish women and 80% for Danish women.

Following pooled analysis of the data, the researchers associated major height loss with a more than doubling in the odds of death from stroke and all types of cardiovascular disease and 71% greater odds of death from all other causes.

These findings remained consistent after the researchers accounted for age, time between height measurements, nationality and baseline values of height, weight, educational attainment and lifestyle factors.

The study could not establish cause, said the researchers, who also noted the small number of stroke deaths, suggesting that the findings should be interpreted with caution.

Other unmeasured factors such as early life physical activity, exposure to tobacco through secondhand smoke or smoking themselves, peak bone mass, underlying health conditions and medical treatments also may have influenced the findings, the researchers said.

Yet the researchers concluded that in northern European women, midlife height loss is a risk factor for earlier mortality. Women who lose height specifically face an increased risk for cardiovascular disease, with death from stroke a major contributor to this association.

Based on these findings, the researchers called for increased attention to height loss to identify individuals at increased risk of cardiovascular disease.

Reference:

Klingberg S, et al. BMJ Open. 2021;doi:10.1136/bmjopen-2021-049122.