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Bone Loss Boosts Cardiovascular Risk 77% in French Aquitaine Cohort
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6th IAS Conference on HIV Pathogenesis, Treatment and Prevention, July 17-20, 2011, Rome
:suggested that the mechanism behind the heart-BMD link is ongoing inflammation reflected in inflammatory factors like tumor necrosis factor-alpha, receptor activator of nuclear factor kappa B (RANK), and RANK ligand system (RANK/RANKL)."
IAS: Heart Disease Signal and Low Femoral Density Linked in People With HIV - written by Mark Mascolini - (07/20/11)
Mark Mascolini
Development of osteopenia or osteoporosis independently raised the risk of cardiovascular disease or treatment in a 12-year prospective study of antiretroviral-treated Aquitaine cohort members [1]. The findings go beyond other research presented at this conference, which found a link between bone loss and a cardiovascular disease marker, coronary artery calcium [2].
Aquitaine, in southwestern France, is home to a prospective cohort of HIV-positive people, most of them taking combination antiretroviral therapy (cART). In this analysis Aquitaine researchers used DEXA scans to measure bone mineral density (BMD) and calculated T and Z scores for lumbar spine, femoral neck, and the whole body in cohort members. The Aquitaine team recorded cardiovascular events from the start of HIV care to the DEXA scan.
The investigators defined cardiovascular events as stroke, acute myocardial infarction, coronary heart disease, coronary artery stenosis, ischemic heart disease, angina pectoris, or treatment for cardiovascular disease. They used logistic regression to identify associations between a cardiovascular event and osteopenia or osteoporosis as defined by the World Health Organization.
The study included 626 people, 167 of them (26.6%) women, 41 of whom (6.5%) were menopausal. Median age stood at 44 years (interquartile range [IQR] 40 to 50). Almost half of the study group (48.7%) smoked, and more than one third (38.5%) had hepatitis C virus (HCV) coinfection.
Nearly everyone (592, or 94.6%) was taking cART, and 73.8% had a viral load below 50 copies. Median CD4 count stood at 504 (IQR 340 to 696), and median follow-up until DEXA scanning was 12.7 years (IQR 7.7 to 17.1).
DEXA showed that 320 cohort members (51.1%) had osteopenia, and 194 (31%) had osteoporosis. Fifty-seven people (9.1%) met cardiovascular event criteria, 26 (4.1%) with a clinical diagnosis and 50 (8%) because they started treatment for heart disease.
Multivariate analysis pinpointed three independent predictors of a cardiovascular event, at the following odds ratios (and 95% confidence intervals):
--Age 55 or older: OR 6.86 (3.27 to 14.41), P < 0.0001
--HCV coinfection: OR 1.83 (1.00 to 3.34), P = 0.050
--Any BMD loss: OR 1.77 (1.12 to 2.79), P = 0.015
Analyzed factors that did not independently predict heart trouble were gender (men versus premenopausal or menopausal women), years of HIV infection, AIDS stage, lowest-ever CD4 count, cART, or smoking. Although smoking is an established heart risk factor, the Aquitaine team noted, their analysis relied on self-reported smoking and did not measure tobacco use.
The results reflect general-population research that found a link between BMD and cardiovascular disease [3,4], especially in postmenopausal women [5,6], but not all such research confirms that association [7].
The Aquitaine researchers suggested that the mechanism behind the heart-BMD link is ongoing inflammation reflected in inflammatory factors like tumor necrosis factor-alpha, receptor activator of nuclear factor kappa B (RANK), and RANK ligand system (RANK/RANKL). The Aquitaine teams called for further investigation of this hypothesis.
References
1. Mehsen N, Lawson-Ayayi S, Schaeverbeke T, et al; Groupe d'Epidemiologie Clinique du SIDA en Aquitaine (GECSA). Cardiovascular risk and osteoporosis are associated in HIV-infected patients, ANRS CO3 Aquitaine Cohort, France. 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention. July 17-20, 2011. Rome. Abstract TUPE246. http://pag.ias2011.org/EPosterHandler.axd?aid=3622.
2. Bellasi A, Zona S, Orlando G, et al. Coronary artery calcification is associated with femoral but not with lumbar spine mineral density. 6th IAS Conference on HIV Pathogenesis, Treatment and Prevention. July 17-20, 2011. Rome. Abstract MOAB0102. http://www.natap.org/2011/IAS/IAS_21.htm.
3. Broussard DL, Magnus JH. Coronary heart disease risk and bone mineral density among U.S. women and men. J Womens Health (Larchmt). 2008;17:479-490.
4. Magnus JH, Broussard DL. Relationship between bone mineral density and myocardial infarction in US adults. Osteoporos Int. 2005;16:2053-2062.
5. Laszlo B, Tanko LB, Christiansen C, Cox DA. Relationship between osteoporosis and cardiovascular disease in postmenopausal women. J Bone Mineral Res. 2005;20:1912-1920.
6. Banks LM, Lees B, MacSweeney JE, Stevenson J. Effect of degenerative spinal and aortic calcification on bone density measurements in post-menopausal women: links between osteoporosis and cardiovascular disease? Eur J Clin Invest. 1994;24:813-817.
7. Mussolino ME, Armenian HK. Low bone mineral density, coronary heart disease, and stroke mortality in men and women: the Third National Health and Nutrition Examination Survey. Ann Epidemiol. 2007;17:841-846.
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