Loss of height predicts total and cardiovascular mortality: a cohort study of northern European women

Abstract

ObjectiveTo examine height changes in middle-aged northern European women in relation to overall and cardiovascular mortality.DesignPopulation-based cohort studies with longitudinally measured heights and register-based mortality.SettingSweden and Denmark.ParticipantsPopulation-based samples of 2406 Swedish and Danish women born on selected years in 1908–1952, recruited to baseline examinations at ages 30–60, and re-examined 10–13 years later.Main outcome measureTotal and cardiovascular disease (CVD) specific mortality during 17–19 years of follow-up after last height measure.ResultsFor each 1 cm height loss during 10–13 years, the HR (95% CI) for total mortality was 1.14 (1.05 to 1.23) in Swedish women and 1.21 (1.09 to 1.35) in Danish women, independent of key covariates. Low height and high leisure time physical activity at baseline were protective of height loss, independent of age. Considering total mortality, the HR for major height loss, defined as height loss greater than 2 cm, were 1.74 (1.32 to 2.29) in Swedish women and 1.80 (1.27 to 2.54) in Danish women. Pooled analyses indicated that height loss was monotonically associated with an increased mortality, confirming a significant effect above 2 cm height loss. For cause-specific mortality, major height loss was associated with a HR of 2.31 (1.09 to 4.87) for stroke mortality, 2.14 (1.47 to 3.12) for total CVD mortality and 1.71 (1.28 to 2.29) for mortality due to causes other than CVD.ConclusionHeight loss is a marker for excess mortality in northern European women. Specifically the hazard of CVD mortality is increased in women with height loss during middle age, and the results suggest that the strongest cause-specific endpoint may be stroke mortality. The present findings suggest attention to height loss in early and mid-adulthood to identify women at high risk of CVD, and that regular physical activity may prevent early onset height loss.

Association between height loss and mortality in the general population

“…An association between height loss and cardiovascular disease has been previously reported 9 – 11 . In this study, we investigated the relationship between height loss and cardiovascular mortality as a secondary outcome, but we could not find an association between height loss and cardiovascular mortality in men.…”

“…Alendronate, a drug used in the treatment of osteoporosis, reportedly reduces height loss by improving bone mineral density 40 . Physical activity has also been reported as being protective against height loss in post-menopausal women 41 , and, in a recent study, regular physical exercise reportedly contributed to prevention of height loss in women 9 . Thus, physical exercise might be one of the possible tools to preventing height loss by maintaining skeletal muscle mass, but whether physical exercise or activity prevents not only height loss, but also its associated comorbidities and mortality, should be examined in the future.…”

“…Associations between height loss and mortality have been shown in several previous studies 7 – 11 . In those studies, height loss of 2–5 cm or more in the long term (4–20 years) were reported to be related to mortality risk in the elderly 7 , 8 , 10 , 11 and in northern European women 9 . Although these previous studies had longer observation periods, ranging from several years to a dozen years, the number of participants was not necessarily sufficient.…”

“…Although osteoporosis is thought to be one of the main factors associated with height loss, especially in the elderly, the resultant height loss affects the normal functioning of the cardiopulmonary and gastrointestinal systems 4 , 5 , which might cause malnutrition and decrease in skeletal muscle mass (sarcopenia) 6 . Several previous studies involving observation for several to a dozen years have reported that marked height loss in the long term is associated with mortality 7 – 11 , fractures 8 , 12 , and cardiovascular diseases 9 – 11 , 13 in the elderly. In these previous studies, relationships between height loss and mortality risk were reported separately in men 11 and women 8 , 9 .…”

“…Several previous studies involving observation for several to a dozen years have reported that marked height loss in the long term is associated with mortality 7 – 11 , fractures 8 , 12 , and cardiovascular diseases 9 – 11 , 13 in the elderly. In these previous studies, relationships between height loss and mortality risk were reported separately in men 11 and women 8 , 9 . Auyeung et al reported that height loss of over 2 cm in 4 years was related to an increased risk of all-cause mortality only in men 7 , suggesting a sex difference in these relationships.…”