by Nicole Lou, Staff Writer, MedPage Today May 6, 2021
Women's osteoporosis screening results could also aid in the evaluation of atherosclerotic cardiovascular disease (ASCVD) risk, according to a study by Korean researchers.
Dual-energy x-ray absorptiometry (DXA) in more than 12,000 women revealed several independent predictors of ASCVD events -- ASCVD death, myocardial infarction (MI), and ischemic stroke -- over a median 9.2 years of follow-up, reported Yeonyee Elizabeth Yoon, MD, of Seoul National University Bundang Hospital, and colleagues:
Furthermore, as shown in the study published online in Heart, the addition of low BMD or a clinical diagnosis of osteopenia or osteoporosis modestly improved upon ASCVD prediction models based on age and traditional risk factors.
"Since bone densitometry forms part of screening for osteoporosis particularly in middle-aged and older women, it is therefore a tantalizing idea if the same assessment could also be used to assess ASCVD risk," said Dexter Canoy, MD, PhD, and Kazem Rahimi, DM, MSc, both of the University of Oxford in England, writing in an accompanying editorial.
They noted that current ASCVD risk prediction algorithms tend to underestimate the risk in women.
"Although the risk prediction could be improved by additional test data, such as the coronary artery calcium [CAC] score, widespread implementation of CAC scanning has been unsuccessful because of the perceived risks of radiation exposure and cost," Yoon and colleagues said.
"In contrast, DXA is widely used to screen for osteopenia and osteoporosis in asymptomatic women. Therefore, the present study results of an improved ASCVD risk prediction by assessing BMD suggest an opportunity to screen women for ASCVD in a manner that is effective, efficient, and broad-reaching," the team suggested.
The association between BMD and atherogenesis has long been established, though the exact mechanism linking the two remains to be fully understood.
"Perhaps it is high time to establish how bone health affects vasculature and understand the underlying pathophysiology that links osteoporotic and atherosclerotic conditions," Canoy and Rahimi wrote. "In doing so, we might just discover new ways to improve the treatment of, and care for, the hearts and minds of women, as well as of men."
For the observational study, Yoon and co-authors used medical records from one medical center in Korea. Included were 12,681 relatively healthy women ages 50-80 (mean 63) who had no history of MI, coronary revascularization, or malignant tumors. Of this cohort, 3.7% had an ASCVD event over follow-up.
Study limitations, the researchers said, included possible confounding due to its retrospective nature, and that it was not possible to adjust for physical activity and steroid use among participants. Parameters related to inflammation, oxidative stress, or disturbed calcium metabolism -- potential mediators between bone and vasculature -- were also left unanalyzed.
"Although using DXA is ideal for screening for osteoporosis, it may not be readily available in other practice settings," Canoy and Rahimi noted. "It remains unclear if alternative, simpler methods of estimating bone density are as predictive as DXA-derived assessments. Further investigations are needed to evaluate economic costs in specific healthcare settings as well as possible harms. Replicating this study in other healthcare settings and populations as well as among men would be very useful."
Nicole Lou is a reporter for MedPage Today, where she covers cardiology news and other developments in medicine. Follow
The study was supported by grants from Seoul National University Bundang Hospital and Hanmi Pharm. Co.
Yoon and co-authors noted no competing interests.
Canoy and Rahimi reported support from the National Institute for Health Research Oxford Biomedical Research Centre, British Heart Foundation, and the Oxford Martin School.
Source Reference: Park J, et al "Prognostic value of lower bone mineral density in predicting adverse cardiovascular disease in Asian women" Heart 2021; DOI: 10.1136/heartjnl-2020-318764.
Source Reference: Canoy D, Rahimi K "A way to a woman's heart might be through her bones" Heart 2021; DOI: 10.1136/heartjnl-2021-319265.
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