2 research outputs found
Bone mineral density and risk of heart failure in older adults: The Cardiovascular Health Study
Background
Despite increasing evidence of a common link between bone and heart health, the relationship between bone mineral density (
BMD
) and heart failure (
HF
) risk remains insufficiently studied.
Methods and Results
We investigated whether
BMD
measured by dual‐energy x‐ray absorptiometry was associated with incident
HF
in an older cohort. Cox models were stratified by sex and interactions of
BMD
with race assessed.
BMD
was examined at the total hip and femoral neck separately, both continuously and by World Health Organization categories. Of 1250 participants, 442 (55% women) developed
HF
during the median follow‐up of 10.5 years. In both black and nonblack women, neither total hip nor femoral neck
BMD
was significantly associated with
HF
; there was no significant interaction by race. In black and nonblack men, total hip, but not femoral neck,
BMD
was significantly associated with
HF
, with evidence of an interaction by race. In nonblack men, lower total hip
BMD
was associated with higher
HF
risk (hazard ratio, 1.13 [95% CI, 1.01–1.26] per 0.1 g/cm
2
decrement), whereas in black men, lower total hip
BMD
was associated with lower
HF
risk (hazard ratio, 0.74 [95% CI, 0.59–0.94]). There were no black men with total hip osteoporosis. Among nonblack men, total hip osteoporosis was associated with higher
HF
risk (hazard ratio, 2.83 [95% CI, 1.39–5.74]) compared with normal
BMD
.
Conclusions
Among older adults, lower total hip
BMD
was associated with higher
HF
risk in nonblack men but lower risk in black men, with no evidence of an association in women. Further research is needed to replicate these findings and to study potential underlying pathways.
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Atrial ectopy as a mediator of the association between race and atrial fibrillation
BackgroundBlacks have a lower risk of atrial fibrillation (AF) despite having more AF risk factors, but the mechanism remains unknown. Premature atrial contraction (PAC) burden is a recently identified risk factor for AF.ObjectiveThe purpose of this study was to determine whether the burden of PACs explains racial differences in AF risk.MethodsPAC burden (number per hour) was assessed by 24-hour ambulatory electrocardiographic (ECG) monitoring in a randomly selected subset of patients in the Cardiovascular Health Study. Participants were followed prospectively for the development of AF, diagnosed by study ECG and hospital admission records.ResultsAmong 938 participants (median age 73 years; 34% black; 58% female), 206 (22%) developed AF over a median follow-up of 11.0 years (interquartile range 6.1-13.4). After adjusting for age, sex, body mass index, coronary disease, congestive heart failure, diabetes, hypertension, alcohol consumption, smoking status, and study site, black race was associated with a 42% lower risk of AF (hazard ratio 0.58, 95% confidence interval [CI] 0.40-0.85; P = .005). The baseline PAC burden was 2.10 times (95% CI 1.57-2.83; P <.001) higher in whites than blacks. There was no detectable difference in premature ventricular contraction (PVC) burden by race. PAC burden mediated 19.5% (95% CI 6.3-52.5) of the adjusted association between race and AF.ConclusionOn average, whites exhibited more PACs than blacks, and this difference statistically explains a modest proportion of the differential risk of AF by race. The differential PAC burden, without differences in PVCs, by race suggests that identifiable common exposures or genetic influences might be important to atrial pathophysiology