The Association of Lipids and Lipoproteins with Hip Fracture Risk: The Cardiovascular Health Study

Barzilay, Joshua I.; Bůžková, Petra; Kuller, Lewis H.; Cauley, Jane A.; Fink, Howard A; Sheets, Kerry M.; Robbins, John A.; Carbone, Laura D; Elam, Rachel; Mukamal, Kenneth J.

doi:10.1016/j.amjmed.2022.05.024

Cited by 10 publications

(15 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Our results contrast with the findings of the Study of Women’s Health Across the Nation (SWAN), which found no association in younger women undergoing a transition through menopause . The Cardiovascular Health Study (CHS), which relied on record linkage with Medicare claims, reported an increased risk of hip fracture in women . Our study is based on stronger methodology and is generalizable to the broad population of healthy older individuals.…”

Section: Discussioncontrasting

confidence: 99%

“…4 The Cardiovascular Health Study (CHS), which relied on record linkage with Medicare claims, reported an increased risk of hip fracture in women. 5 Our study is based on stronger methodology and is generalizable to the broad population of healthy older individuals.…”

Section: Discussionmentioning

confidence: 99%

“…9 This association is in keeping with the lack of cardiovascular or other benefits generally seen in all participants in clinical trials of agents that increase HDL-C levels, although none of these studies reported fracture risk. 4) 401 ( 4) 143 (5) Other trauma fracture 948 ( 6) 245 ( 5) 506 ( 6) 197 (7) Age, mean (SD), y 75 ( 4) 75 ( 4) 75 ( 4) 76 ( 5 Mechanisms whereby a raised HDL-C level might increase fracture risk are unclear. A prime consideration would be confounding by factors such as increased physical activity, which could increase HDL-C but also increase fracture risk.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Association of Plasma High-Density Lipoprotein Cholesterol Level With Risk of Fractures in Healthy Older Adults

et al. 2023

View full text Add to dashboard Cite

ImportanceIncreased levels of high-density lipoprotein cholesterol (HDL-C) have been associated with osteoporosis. Preclinical studies have reported that HDL-C reduces bone mineral density by reducing osteoblast number and function. However, the clinical significance of these findings is unclear.ObjectiveTo determine whether higher HDL-C levels are predictive of an increased fracture risk in healthy older adults.Design, Setting, and ParticipantsThis cohort study is a post hoc analysis of data from the Aspirin in Reducing Events in the Elderly (ASPREE) clinical trial and the ASPREE-Fracture substudy. ASPREE was a double-blind, randomized, placebo-controlled primary prevention trial of aspirin that recruited participants between 2010 and 2014. These comprised community-based older adults (16 703 Australians aged ≥70 years, 2411 US participants ≥65 years) without evident cardiovascular disease, dementia, physical disability, and life-limiting chronic illness. The ASPREE-Fracture substudy collected data on fractures reported postrandomization from Australian participants. Cox regression was used to calculate hazard ratio (HR) and 95% CI. Data analysis for this study was performed from April to August 2022.ExposurePlasma HDL-C.Main Outcomes and MeasuresFractures included were confirmed by medical imaging and included both traumatic and minimal trauma fractures. Fractures were adjudicated by an expert review panel.ResultsOf the 16 262 participants who had a plasma HDL-C measurement at baseline (8945 female participants [55%] and 7319 male [45%]), 1659 experienced at least 1 fracture over a median (IQR) of 4.0 years (0.02-7.0 years). In a fully adjusted model, each 1-SD increment in HDL-C level was associated with a 14% higher risk of fractures (HR, 1.14; 95% CI, 1.08-1.20). The results remained similar when these analyses were stratified by sex. Sensitivity and stratified analyses demonstrated that these associations persisted when the analyses were repeated to include only (1) minimal trauma fractures, (2) participants not taking osteoporosis medications, (3) participants who were never smokers and reported that they did not drink alcohol, and (4) participants who walked outside for less than 30 minutes per day and reported no participation in moderate/vigorous physical activity and to examine only (5) statin use. No association was observed between non–HDL-C levels and fractures.Conclusions and RelevanceThis study suggests that higher levels of HDL-C are associated with an increased fracture risk. This association was independent of common risk factors for fractures.

show abstract

Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Association of Plasma High-Density Lipoprotein Cholesterol Level With Risk of Fractures in Healthy Older Adults

et al. 2023

View full text Add to dashboard Cite

show abstract

“…The most striking difference in the findings was the shape of the association between HDL-C and fracture risk. Whereas the HDL-C association was U-shaped in the CHS, 7 similar to other findings for CV disease, it was direct and linear in the current ASPREE trial cohort. 1 Furthermore, the study in the CHS assessed only hip fracture risk whereas the ASPREE trial cohort assessed multiple types of fractures.…”

Section: Related Articlesupporting

confidence: 86%

Higher High-Density Lipoprotein Cholesterol—Good Omen, Bad Omen, or Not an Omen at All

Wilkins

Rohatgi

2023

JAMA Cardiol

View full text Add to dashboard Cite

“…In a prospective cohort study following 5832 participants aged ≥ 65 years from the Cardiovascular Health Study for hip fracture for a mean of 13.5 (SD 5.7) years. LDL levels were found to have a statistically significant nonlinear U-shaped relationship with hip fracture risk ( p = 0.02) [ 28 ]. LDL cholesterol comprises 90% of the circulating cholesterol in most people; therefore, there is a high correlation between total cholesterol and LDL levels [ 29 ].…”

Section: Introductionmentioning

confidence: 99%

Evaluation of the Association between Low-Density Lipoprotein (LDL) and All-Cause Mortality in Geriatric Patients with Hip Fractures: A Prospective Cohort Study of 339 Patients

Kang

Tian

Zhao

et al. 2023

JPM

View full text Add to dashboard Cite

Background: Many factors affect the prognosis of hip fractures in the elderly. Some studies have suggested a direct or indirect association among serum lipid levels, osteoporosis, and hip fracture risk. LDL levels were found to have a statistically significant nonlinear U-shaped relationship with hip fracture risk. However, the relationship between serum LDL levels and the prognosis of patients with hip fractures remains unclear. Therefore, in this study, we assessed the influence of serum LDL levels on patient mortality over a long-term follow-up period. Methods: Elderly patients with hip fractures were screened between January 2015 and September 2019, and their demographic and clinical characteristics were collected. Linear and nonlinear multivariate Cox regression models were used to identify the association between LDL levels and mortality. Analyses were performed using Empower Stats and R software. Results: Overall, 339 patients with a mean follow-up period of 34.17 months were included in this study. Ninety-nine patients (29.20%) died due to all-cause mortality. Linear multivariate Cox regression models showed that LDL levels were associated with mortality (HR = 0.69, 95%CI: 0.53, 0.91, p = 0.0085) after adjusting for confounding factors. However, the linear association was unstable, and nonlinearity was identified. An LDL concentration of 2.31 mmol/L was defined as the inflection point for prediction. A LDL level < 2.31 mmol/L was associated with mortality (HR = 0.42, 95%CI: 0.25, 0.69, p = 0.0006), whereas LDL > 2.31 mmol/L was not a risk factor for mortality (HR = 1.06, 95%CI: 0.70, 1.63, p = 0.7722). Conclusions: The preoperative LDL level was nonlinearly associated with mortality in elderly patients with hip fractures, and the LDL level was a risk indicator of mortality. Furthermore, 2.31 mmol/L could be considered a predictor cut-off for risk.

show abstract

The Association of Lipids and Lipoproteins with Hip Fracture Risk: The Cardiovascular Health Study

Cited by 10 publications

References 36 publications

Association of Plasma High-Density Lipoprotein Cholesterol Level With Risk of Fractures in Healthy Older Adults

Association of Plasma High-Density Lipoprotein Cholesterol Level With Risk of Fractures in Healthy Older Adults

Higher High-Density Lipoprotein Cholesterol—Good Omen, Bad Omen, or Not an Omen at All

Evaluation of the Association between Low-Density Lipoprotein (LDL) and All-Cause Mortality in Geriatric Patients with Hip Fractures: A Prospective Cohort Study of 339 Patients

Contact Info

Product

Resources

About